Provider Demographics
NPI:1811100332
Name:HOUSHI, FARZANEH (EDD)
Entity type:Individual
Prefix:DR
First Name:FARZANEH
Middle Name:
Last Name:HOUSHI
Suffix:
Gender:F
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:612 BEVERLY DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22305-1301
Mailing Address - Country:US
Mailing Address - Phone:703-549-2813
Mailing Address - Fax:703-549-2813
Practice Address - Street 1:15313 POTOMAC RIVER DR.
Practice Address - Street 2:
Practice Address - City:COBB ISLAND
Practice Address - State:MD
Practice Address - Zip Code:20625-0171
Practice Address - Country:US
Practice Address - Phone:301-259-2747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD02338103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDG471Medicare ID - Type UnspecifiedMEDICARE ID NUMBER