Provider Demographics
NPI:1649813395
Name:NIV, NOOSHAFARIN (PHD)
Entity type:Individual
Prefix:DR
First Name:NOOSHAFARIN
Middle Name:
Last Name:NIV
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:NOOSHA
Other - Middle Name:
Other - Last Name:NIV
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:3923 RODERICK RD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90065-3737
Mailing Address - Country:US
Mailing Address - Phone:310-528-7554
Mailing Address - Fax:
Practice Address - Street 1:655 N CENTRAL AVE STE 1704
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91203-1422
Practice Address - Country:US
Practice Address - Phone:310-528-7554
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-25
Last Update Date:2019-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY28157103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical