Provider Demographics
NPI:1952500274
Name:HADAVI, MARZIEH (LMSW, LCPSYA)
Entity Type:Individual
Prefix:MS
First Name:MARZIEH
Middle Name:
Last Name:HADAVI
Suffix:
Gender:F
Credentials:LMSW, LCPSYA
Other - Prefix:MS
Other - First Name:MARZIEH
Other - Middle Name:TAGHIZADEH
Other - Last Name:MOGHADAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:112 CROYDEN AVE
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11023-1730
Mailing Address - Country:US
Mailing Address - Phone:516-466-8203
Mailing Address - Fax:
Practice Address - Street 1:16 W 10TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-8707
Practice Address - Country:US
Practice Address - Phone:212-228-6036
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-16
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000423102L00000X
NY0700581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical