Provider Demographics
NPI:1861627960
Name:NASSERBAKHT, AFSANEH (PHD)
Entity Type:Individual
Prefix:DR
First Name:AFSANEH
Middle Name:
Last Name:NASSERBAKHT
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 1:555 BRYANT ST.
Mailing Address - Street 2:#529
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94301
Mailing Address - Country:US
Mailing Address - Phone:650-283-7782
Mailing Address - Fax:
Practice Address - Street 1:18809 COX AVE.
Practice Address - Street 2:#290
Practice Address - City:SARATOGA
Practice Address - State:CA
Practice Address - Zip Code:95070
Practice Address - Country:US
Practice Address - Phone:650-283-7782
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-19
Last Update Date:2009-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY19985103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist