Provider Demographics
NPI:1841414125
Name:RAHIMI, AZADEH (PHD)
Entity Type:Individual
Prefix:DR
First Name:AZADEH
Middle Name:
Last Name:RAHIMI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 260343
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91426-0343
Mailing Address - Country:US
Mailing Address - Phone:818-907-5151
Mailing Address - Fax:818-784-2222
Practice Address - Street 1:16661 VENTURA BLVD
Practice Address - Street 2:SUITE 520
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-1914
Practice Address - Country:US
Practice Address - Phone:818-907-5251
Practice Address - Fax:818-784-2222
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-11
Last Update Date:2010-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY15484102L00000X, 103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP15484Medicare ID - Type UnspecifiedCLINICAL PSYCHOLOGIST