Provider Demographics
NPI:1821870569
Name:HAYATGHAIB, NEALUFAR LILLIAN (MA)
Entity Type:Individual
Prefix:
First Name:NEALUFAR
Middle Name:LILLIAN
Last Name:HAYATGHAIB
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:LILLIAN
Other - Middle Name:
Other - Last Name:HAYATGHAIB
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MA
Mailing Address - Street 1:15466 LOS GATOS BLVD STE 109-241
Mailing Address - Street 2:
Mailing Address - City:LOS GATOS
Mailing Address - State:CA
Mailing Address - Zip Code:95032-2542
Mailing Address - Country:US
Mailing Address - Phone:408-221-7610
Mailing Address - Fax:
Practice Address - Street 1:15466 LOS GATOS BLVD STE 109-241
Practice Address - Street 2:
Practice Address - City:LOS GATOS
Practice Address - State:CA
Practice Address - Zip Code:95032-2542
Practice Address - Country:US
Practice Address - Phone:408-221-7610
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-17
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA139236101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health