Provider Demographics
NPI:1144480864
Name:REZAIYAN, AZIZEH E (MA, MFT)
Entity type:Individual
Prefix:MS
First Name:AZIZEH
Middle Name:E
Last Name:REZAIYAN
Suffix:
Gender:F
Credentials:MA, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:840 HINCKLEY RD
Mailing Address - Street 2:#110
Mailing Address - City:BURLINGAME
Mailing Address - State:CA
Mailing Address - Zip Code:94010-1516
Mailing Address - Country:US
Mailing Address - Phone:650-692-9664
Mailing Address - Fax:650-738-3033
Practice Address - Street 1:840 HINCKLEY RD
Practice Address - Street 2:#110
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-1516
Practice Address - Country:US
Practice Address - Phone:650-692-9664
Practice Address - Fax:650-738-3033
Is Sole Proprietor?:No
Enumeration Date:2008-06-16
Last Update Date:2008-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC# 39248106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist