Provider Demographics
NPI:1821232166
Name:AZAD, NAHID (MFT)
Entity Type:Individual
Prefix:MRS
First Name:NAHID
Middle Name:
Last Name:AZAD
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6979 HOLLOW LAKE WAY
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95120-5814
Mailing Address - Country:US
Mailing Address - Phone:408-920-1977
Mailing Address - Fax:408-997-9670
Practice Address - Street 1:6489 CAMDEN AVE STE 103
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95120-2850
Practice Address - Country:US
Practice Address - Phone:408-920-1977
Practice Address - Fax:408-997-9670
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-30
Last Update Date:2009-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 34273106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist