Provider Demographics
NPI:1952147449
Name:DR NAHAL C KAIVAN PSYCHOLOGICAL SERVICES PLLC
Entity type:Organization
Organization Name:DR NAHAL C KAIVAN PSYCHOLOGICAL SERVICES PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINIC DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NAHAL
Authorized Official - Middle Name:
Authorized Official - Last Name:KAIVAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:858-735-5425
Mailing Address - Street 1:2001 PALMER AVE STE 205
Mailing Address - Street 2:
Mailing Address - City:LARCHMONT
Mailing Address - State:NY
Mailing Address - Zip Code:10538-2420
Mailing Address - Country:US
Mailing Address - Phone:917-979-8736
Mailing Address - Fax:914-292-9166
Practice Address - Street 1:2001 PALMER AVE STE 205
Practice Address - Street 2:
Practice Address - City:LARCHMONT
Practice Address - State:NY
Practice Address - Zip Code:10538-2420
Practice Address - Country:US
Practice Address - Phone:917-979-8736
Practice Address - Fax:914-292-9166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-03
Last Update Date:2024-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty