Provider Demographics
NPI:1942769401
Name:TAKAHASHI, NASSIM MOALEMI (BCBA)
Entity Type:Individual
Prefix:
First Name:NASSIM
Middle Name:MOALEMI
Last Name:TAKAHASHI
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:NASSIM
Other - Middle Name:MORGAN
Other - Last Name:MOALEMI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BCBA
Mailing Address - Street 1:4775 LONG BRANCH AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92107-2214
Mailing Address - Country:US
Mailing Address - Phone:714-595-7455
Mailing Address - Fax:
Practice Address - Street 1:4775 LONG BRANCH AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92107-2214
Practice Address - Country:US
Practice Address - Phone:714-595-7455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-14
Last Update Date:2023-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1-20-42432103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3430OtherLICENSED BEHAVIOR ANALYST