Provider Demographics
NPI:1497864441
Name:ALI, HARUN MARVIN (PSYD, LCSW)
Entity Type:Individual
Prefix:DR
First Name:HARUN
Middle Name:MARVIN
Last Name:ALI
Suffix:
Gender:M
Credentials:PSYD, LCSW
Other - Prefix:DR
Other - First Name:MARVIN
Other - Middle Name:
Other - Last Name:ALI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD, LCSW
Mailing Address - Street 1:250 DOS RIOS ST STE A1
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95811-0442
Mailing Address - Country:US
Mailing Address - Phone:916-930-0066
Mailing Address - Fax:
Practice Address - Street 1:5271 W PALO ALTO AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93722-3635
Practice Address - Country:US
Practice Address - Phone:559-276-2331
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2021-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS232291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical