Provider Demographics
NPI:1770860868
Name:YASHAR, SEPIDEH (PSYD)
Entity Type:Individual
Prefix:
First Name:SEPIDEH
Middle Name:
Last Name:YASHAR
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:136 S PALM DR
Mailing Address - Street 2:202
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-3545
Mailing Address - Country:US
Mailing Address - Phone:310-633-3523
Mailing Address - Fax:
Practice Address - Street 1:136 S PALM DR
Practice Address - Street 2:202
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-3545
Practice Address - Country:US
Practice Address - Phone:310-633-3523
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-03
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24455103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist