Provider Demographics
NPI:1205450335
Name:MAJD-FARIDI, ANDREA (LCSW)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:
Last Name:MAJD-FARIDI
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3383
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92605-3383
Mailing Address - Country:US
Mailing Address - Phone:949-677-9419
Mailing Address - Fax:
Practice Address - Street 1:8941 ATLANTA AVE # 371
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92646-7121
Practice Address - Country:US
Practice Address - Phone:949-677-9419
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-04
Last Update Date:2020-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24806101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional