Provider Demographics
NPI:1487183307
Name:FARIBA RABIZADEH MARRIAGE FAMILY THERAPIST A PROF CORP
Entity Type:Organization
Organization Name:FARIBA RABIZADEH MARRIAGE FAMILY THERAPIST A PROF CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MFT
Authorized Official - Prefix:MRS
Authorized Official - First Name:FARIBA
Authorized Official - Middle Name:
Authorized Official - Last Name:RABIZADEH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-625-2600
Mailing Address - Street 1:12304 SANTA MONICA BLVD STE 314
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-2551
Mailing Address - Country:US
Mailing Address - Phone:310-625-2600
Mailing Address - Fax:
Practice Address - Street 1:12304 SANTA MONICA BLVD STE 314
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-2551
Practice Address - Country:US
Practice Address - Phone:310-625-2600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-06-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT50167106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty