Provider Demographics
NPI:1851858708
Name:TABRIZI, SYAMAK HAKIMI (ASW, CATC IV)
Entity Type:Individual
Prefix:
First Name:SYAMAK
Middle Name:HAKIMI
Last Name:TABRIZI
Suffix:
Gender:M
Credentials:ASW, CATC IV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12905 MAPLEVIEW ST APT 103
Mailing Address - Street 2:
Mailing Address - City:LAKESIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92040-2063
Mailing Address - Country:US
Mailing Address - Phone:760-990-3747
Mailing Address - Fax:
Practice Address - Street 1:73 N 2ND AVE
Practice Address - Street 2:
Practice Address - City:CHULA VISTA
Practice Address - State:CA
Practice Address - Zip Code:91910-1124
Practice Address - Country:US
Practice Address - Phone:619-426-0034
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-27
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
CA199584101YA0400X
CAASW96334101YM0800X, 104100000X, 390200000X, 1041C0700X
CA96334101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program