Provider Demographics
NPI:1588834865
Name:SAFAEIAN, SIAMAK (PHD, LISAC)
Entity Type:Individual
Prefix:
First Name:SIAMAK
Middle Name:
Last Name:SAFAEIAN
Suffix:
Gender:M
Credentials:PHD, LISAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12144 E PARADISE DR
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85259-3341
Mailing Address - Country:US
Mailing Address - Phone:480-518-3389
Mailing Address - Fax:480-664-6776
Practice Address - Street 1:12144 E PARADISE DR
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85259-3341
Practice Address - Country:US
Practice Address - Phone:480-518-3389
Practice Address - Fax:480-664-6776
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-03
Last Update Date:2008-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ11819101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ20763585Medicaid