Provider Demographics
NPI:1881210722
Name:H C DAVOODZADEH LICENSED CLINICAL SOCIAL WORKER INC A PROFESSIONAL C
Entity Type:Organization
Organization Name:H C DAVOODZADEH LICENSED CLINICAL SOCIAL WORKER INC A PROFESSIONAL C
Other - Org Name:SABOOR SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CLINICIAN/CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:HANNA
Authorized Official - Middle Name:C
Authorized Official - Last Name:DAVOODZADEH
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:661-733-9935
Mailing Address - Street 1:2233 CAROLYN DR
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93551-5427
Mailing Address - Country:US
Mailing Address - Phone:661-733-9935
Mailing Address - Fax:
Practice Address - Street 1:2233 CAROLYN DR
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551-5427
Practice Address - Country:US
Practice Address - Phone:661-733-9935
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-16
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Multi-Specialty