Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103TA0400X | Addiction Psychologist (Substance Use Disorder) | PSY16456 | CA |
Y | 103TB0200X | Cognitive & Behavioral Psychologist | PSY16456 | CA |
N | 103TF0200X | Forensic Psychologist | PSY16456 | CA |
NPI | 1639429996 |
---|---|
Provider Name | Azadeh Famili |
First Address | Glendora, CA 91741-2607 |
Second Address | Glendora, CA 91741-2607 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/09/2012 |
Last Update Date | 13/09/2012 |