Provider Demographics
NPI:1679107346
Name:AGHAEINEJAD, YASAMAN (LCSW)
Entity Type:Individual
Prefix:
First Name:YASAMAN
Middle Name:
Last Name:AGHAEINEJAD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 HERMITAGE RD UNIT 2324
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23220-1342
Mailing Address - Country:US
Mailing Address - Phone:804-405-0586
Mailing Address - Fax:
Practice Address - Street 1:7489 RIGHT FLANK RD STE 330
Practice Address - Street 2:
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23116-3845
Practice Address - Country:US
Practice Address - Phone:804-398-8401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-02
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040113771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical