Provider Demographics
NPI:1396138996
Name:TAEFI, AZADEH (MS, PPS, CWA)
Entity type:Individual
Prefix:
First Name:AZADEH
Middle Name:
Last Name:TAEFI
Suffix:
Gender:F
Credentials:MS, PPS, CWA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1697 VIA ALEGRE
Mailing Address - Street 2:
Mailing Address - City:SAN DIMAS
Mailing Address - State:CA
Mailing Address - Zip Code:91773-4222
Mailing Address - Country:US
Mailing Address - Phone:779-429-2334
Mailing Address - Fax:
Practice Address - Street 1:1697 VIA ALEGRE
Practice Address - Street 2:
Practice Address - City:SAN DIMAS
Practice Address - State:CA
Practice Address - Zip Code:91773-4222
Practice Address - Country:US
Practice Address - Phone:779-429-2334
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-06
Last Update Date:2025-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
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No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool
No102X00000XBehavioral Health & Social Service ProvidersPoetry Therapist