Provider Demographics
NPI:1710181185
Name:HABROUN, NAMAZ (BA)
Entity Type:Individual
Prefix:MS
First Name:NAMAZ
Middle Name:
Last Name:HABROUN
Suffix:
Gender:F
Credentials:BA
Other - Prefix:MS
Other - First Name:NAMAZ
Other - Middle Name:
Other - Last Name:HABROUN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, BCBA
Mailing Address - Street 1:11211 RANCHO CORDOVA ST
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93311-9128
Mailing Address - Country:US
Mailing Address - Phone:661-477-5977
Mailing Address - Fax:
Practice Address - Street 1:12010 ROARING RIVER AVE
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93311-9308
Practice Address - Country:US
Practice Address - Phone:661-663-0898
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-12
Last Update Date:2021-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-19-34549103K00000X
171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst