Provider Demographics
NPI:1679853899
Name:IRANI, FARZIN (PHD)
Entity Type:Individual
Prefix:DR
First Name:FARZIN
Middle Name:
Last Name:IRANI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:FARZIN
Other - Middle Name:
Other - Last Name:IRANI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:101 LINDENWOOD DR
Mailing Address - Street 2:SUITE 225
Mailing Address - City:MALVERN
Mailing Address - State:PA
Mailing Address - Zip Code:19355-1755
Mailing Address - Country:US
Mailing Address - Phone:484-870-5608
Mailing Address - Fax:484-870-5609
Practice Address - Street 1:101 LINDENWOOD DR
Practice Address - Street 2:SUITE 225
Practice Address - City:MALVERN
Practice Address - State:PA
Practice Address - Zip Code:19355-1755
Practice Address - Country:US
Practice Address - Phone:484-870-5608
Practice Address - Fax:484-870-5609
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-18
Last Update Date:2013-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS017067103G00000X, 103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical