Provider Demographics
NPI:1568776870
Name:ERFANIAN, NASRIN (PHD)
Entity Type:Individual
Prefix:
First Name:NASRIN
Middle Name:
Last Name:ERFANIAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4726 N HABANA AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:TAMPA
Mailing Address - State:FL
Mailing Address - Zip Code:33614-7144
Mailing Address - Country:US
Mailing Address - Phone:813-872-7582
Mailing Address - Fax:813-873-9591
Practice Address - Street 1:4726 N HABANA AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33614-7144
Practice Address - Country:US
Practice Address - Phone:813-872-7582
Practice Address - Fax:813-873-9591
Is Sole Proprietor?:No
Enumeration Date:2010-07-28
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1073511103K00000X
FLPY7700103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst