Provider Demographics
NPI:1891960944
Name:SIASSI, SHAHRZAD FOZOUNI (PHD)
Entity Type:Individual
Prefix:
First Name:SHAHRZAD
Middle Name:FOZOUNI
Last Name:SIASSI
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 1:15206 VENTURA BLVD
Mailing Address - Street 2:SUITE 206
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403
Mailing Address - Country:US
Mailing Address - Phone:818-981-2923
Mailing Address - Fax:818-981-2923
Practice Address - Street 1:15206 VENTURA BLVD
Practice Address - Street 2:SUITE # 206
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403
Practice Address - Country:US
Practice Address - Phone:818-981-2923
Practice Address - Fax:818-981-2923
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-29
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY10724103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist