Provider Demographics
NPI:1558962324
Name:KHALITCHI-ALAVI, MARJANEH-MARCIA (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MARJANEH-MARCIA
Middle Name:
Last Name:KHALITCHI-ALAVI
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:MARCIA
Other - Middle Name:K
Other - Last Name:ALAVI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:16221 QUEMADA ROAD
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436
Mailing Address - Country:US
Mailing Address - Phone:818-257-2007
Mailing Address - Fax:
Practice Address - Street 1:12400 WILSHIRE BLVD #230
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025
Practice Address - Country:US
Practice Address - Phone:818-257-2007
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-06
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32068103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical