Provider Demographics
NPI:1477927903
Name:DANESHRAD, NAGHMEH
Entity type:Individual
Prefix:
First Name:NAGHMEH
Middle Name:
Last Name:DANESHRAD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:
Other - Last Name:DANESH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5542 MODENA PL
Mailing Address - Street 2:
Mailing Address - City:AGOURA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91301-1913
Mailing Address - Country:US
Mailing Address - Phone:818-429-9880
Mailing Address - Fax:
Practice Address - Street 1:5542 MODENA PL
Practice Address - Street 2:
Practice Address - City:AGOURA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91301-1913
Practice Address - Country:US
Practice Address - Phone:818-429-9880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-20
Last Update Date:2015-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health