Provider Demographics
NPI:1558711697
Name:BAIEDI, MARIAM ELIZABETH
Entity Type:Individual
Prefix:
First Name:MARIAM
Middle Name:ELIZABETH
Last Name:BAIEDI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4412 CALIFORNIA AVE SW UNIT 16516
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98116-0827
Mailing Address - Country:US
Mailing Address - Phone:626-210-0019
Mailing Address - Fax:
Practice Address - Street 1:219 N INDIAN HILL BLVD #202A
Practice Address - Street 2:
Practice Address - City:CLAREMONT
Practice Address - State:CA
Practice Address - Zip Code:91711
Practice Address - Country:US
Practice Address - Phone:626-210-0019
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-20
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86193101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health