Provider Demographics
NPI:1649397548
Name:AMJADI, TAGHI M (PHD, MFT)
Entity Type:Individual
Prefix:
First Name:TAGHI
Middle Name:M
Last Name:AMJADI
Suffix:
Gender:M
Credentials:PHD, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:544 INTERNATIONAL BLVD
Mailing Address - Street 2:#9
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94606-2973
Mailing Address - Country:US
Mailing Address - Phone:510-277-2836
Mailing Address - Fax:
Practice Address - Street 1:14651 S BASCOM AVE
Practice Address - Street 2:STE 230
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-2014
Practice Address - Country:US
Practice Address - Phone:408-358-8090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC41699106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist