Provider Demographics
NPI:1619113446
Name:GHANIZADEH, HALEH (MD, MPH)
Entity Type:Individual
Prefix:
First Name:HALEH
Middle Name:
Last Name:GHANIZADEH
Suffix:
Gender:F
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 537
Mailing Address - Street 2:
Mailing Address - City:RIDGEFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06877-0537
Mailing Address - Country:US
Mailing Address - Phone:203-438-2441
Mailing Address - Fax:203-438-1011
Practice Address - Street 1:83 WEST LN
Practice Address - Street 2:
Practice Address - City:RIDGEFIELD
Practice Address - State:CT
Practice Address - Zip Code:06877-4905
Practice Address - Country:US
Practice Address - Phone:203-438-2441
Practice Address - Fax:203-438-1011
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-29
Last Update Date:2008-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT0412492084F0202X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084F0202XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyForensic Psychiatry
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry