Provider Demographics
NPI:1508997990
Name:MEHDIZADEH, MAHASTEE MARY (MS)
Entity Type:Individual
Prefix:
First Name:MAHASTEE
Middle Name:MARY
Last Name:MEHDIZADEH
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12032 ORANGE ST
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CA
Mailing Address - Zip Code:90650-8113
Mailing Address - Country:US
Mailing Address - Phone:562-868-8619
Mailing Address - Fax:
Practice Address - Street 1:12032 ORANGE ST
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650-8113
Practice Address - Country:US
Practice Address - Phone:562-868-8619
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAIMF 43465106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist