Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker |
NPI | 1003241381 |
---|---|
Provider Name | Sarit Fassazadeh |
First Address | Long Beach, CA 90802-2426 |
Second Address | Long Beach, CA 90802-2426 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/09/2013 |
Last Update Date | 24/06/2014 |