Provider Demographics
NPI:1609423995
Name:NIZAMI, NAZNEEN (LMFT, PSYD)
Entity Type:Individual
Prefix:
First Name:NAZNEEN
Middle Name:
Last Name:NIZAMI
Suffix:
Gender:F
Credentials:LMFT, PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5232 HUNTSWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:LA PALMA
Mailing Address - State:CA
Mailing Address - Zip Code:90623-1714
Mailing Address - Country:US
Mailing Address - Phone:714-523-2730
Mailing Address - Fax:
Practice Address - Street 1:20377 SW ACACIA ST STE 110
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-0781
Practice Address - Country:US
Practice Address - Phone:714-768-4601
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-21
Last Update Date:2022-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
CA126263106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician