Provider Demographics
NPI:1902455025
Name:AZIZODDIN, DESIREE RACHEL (PSYD)
Entity Type:Individual
Prefix:MRS
First Name:DESIREE
Middle Name:RACHEL
Last Name:AZIZODDIN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1933 COMMONWEALTH AVE APT 311
Mailing Address - Street 2:
Mailing Address - City:BRIGHTON
Mailing Address - State:MA
Mailing Address - Zip Code:02135-5941
Mailing Address - Country:US
Mailing Address - Phone:626-826-7984
Mailing Address - Fax:
Practice Address - Street 1:1051 BEACON ST STE 101
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-5622
Practice Address - Country:US
Practice Address - Phone:857-280-1440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-11
Last Update Date:2019-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA11043103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist