Provider Demographics
NPI:1710349360
Name:ESHTEHARDI, NAAZGOL (MA, EDM, LMHC)
Entity Type:Individual
Prefix:
First Name:NAAZGOL
Middle Name:
Last Name:ESHTEHARDI
Suffix:
Gender:F
Credentials:MA, EDM, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:687 DRIGGS AVE APT 3N
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11211-4005
Mailing Address - Country:US
Mailing Address - Phone:917-426-1363
Mailing Address - Fax:
Practice Address - Street 1:14 PENN PLZ FRNT 4
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10122-0003
Practice Address - Country:US
Practice Address - Phone:323-213-3037
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-23
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007100101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health