Provider Demographics
NPI:1629129671
Name:NAFISSI, CATHERINE ANOOSHEH (MFT)
Entity Type:Individual
Prefix:MRS
First Name:CATHERINE
Middle Name:ANOOSHEH
Last Name:NAFISSI
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4600 EL CAMINO REAL STE 204
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94022-1328
Mailing Address - Country:US
Mailing Address - Phone:650-888-7999
Mailing Address - Fax:650-440-4981
Practice Address - Street 1:4600 EL CAMINO REAL STE 204
Practice Address - Street 2:
Practice Address - City:LOS ALTOS
Practice Address - State:CA
Practice Address - Zip Code:94022-1328
Practice Address - Country:US
Practice Address - Phone:650-888-7999
Practice Address - Fax:650-440-4981
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-16
Last Update Date:2016-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA36331106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA80506OtherGROUP #