Provider Demographics
NPI:1922367929
Name:TOOMARI, SHAHDOKHT S (PSYD)
Entity Type:Individual
Prefix:
First Name:SHAHDOKHT
Middle Name:S
Last Name:TOOMARI
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9107 WILSHIRE BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-5522
Mailing Address - Country:US
Mailing Address - Phone:310-279-2878
Mailing Address - Fax:310-570-2249
Practice Address - Street 1:9107 WILSHIRE BLVD STE 200
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-5522
Practice Address - Country:US
Practice Address - Phone:310-279-2878
Practice Address - Fax:310-570-2249
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-10
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY23664103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY23664OtherCA STATE LICENCE