Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 071009339 | IL |
Y | 103TC0700X | Clinical Psychologist | 071009339 | IL |
NPI | 1003369646 |
---|---|
Provider Name | Dr. Mahsa Mirazimy |
First Address | Chicago, IL 60601-4000 |
Second Address | Chicago, IL 60601-4000 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2016 |
Last Update Date | 25/01/2021 |