Provider Demographics
NPI:1558554295
Name:MOTTAGHIAN, PARIVASH (PSYCHOLOGIST)
Entity Type:Individual
Prefix:MRS
First Name:PARIVASH
Middle Name:
Last Name:MOTTAGHIAN
Suffix:
Gender:F
Credentials:PSYCHOLOGIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4139 PETERS WAY
Mailing Address - Street 2:
Mailing Address - City:ROCKLIN
Mailing Address - State:CA
Mailing Address - Zip Code:95765-6053
Mailing Address - Country:US
Mailing Address - Phone:916-960-7094
Mailing Address - Fax:
Practice Address - Street 1:4139 PETERS WAY
Practice Address - Street 2:
Practice Address - City:ROCKLIN
Practice Address - State:CA
Practice Address - Zip Code:95765-6053
Practice Address - Country:US
Practice Address - Phone:916-960-7094
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-27
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY33355103TC0700X
106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist