Provider Demographics
NPI:1619487287
Name:ALLIED PSYCHOLOGICAL SERVICES, P.C.
Entity Type:Organization
Organization Name:ALLIED PSYCHOLOGICAL SERVICES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/ CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:SAMIRA
Authorized Official - Middle Name:
Authorized Official - Last Name:VAFADAR
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:714-394-0017
Mailing Address - Street 1:21 CROCKETT
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92620-3331
Mailing Address - Country:US
Mailing Address - Phone:714-394-0017
Mailing Address - Fax:
Practice Address - Street 1:23 CORPORATE PLAZA DR STE 150
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7908
Practice Address - Country:US
Practice Address - Phone:949-329-7337
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-09
Last Update Date:2020-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY28213OtherBOARD OF PSYCHOLOGY