Provider Demographics
NPI:1922122589
Name:HOMAYOUNJAM, HALEH (PSYD)
Entity Type:Individual
Prefix:DR
First Name:HALEH
Middle Name:
Last Name:HOMAYOUNJAM
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:HALEH
Other - Middle Name:
Other - Last Name:STAHL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PSYD
Mailing Address - Street 1:314 12TH ST
Mailing Address - Street 2:MS 115 MENTAL HEALTH SERVICES CHILDRENS HOSPITAL
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90402-2014
Mailing Address - Country:US
Mailing Address - Phone:310-614-0760
Mailing Address - Fax:
Practice Address - Street 1:499 N CANON DR
Practice Address - Street 2:STE 407
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4887
Practice Address - Country:US
Practice Address - Phone:310-614-0760
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-19
Last Update Date:2017-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY16744103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist