Provider Demographics
NPI:1245527035
Name:MICHLIN, PARIVASH MINOU (LCSW)
Entity type:Individual
Prefix:DR
First Name:PARIVASH
Middle Name:MINOU
Last Name:MICHLIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MISS
Other - First Name:PARIVASH
Other - Middle Name:
Other - Last Name:SOUMEKH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DSW
Mailing Address - Street 1:412 N MAPLE DR UNIT A
Mailing Address - Street 2:UNIT A
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90210-3819
Mailing Address - Country:US
Mailing Address - Phone:424-249-3099
Mailing Address - Fax:424-249-3099
Practice Address - Street 1:412 N MAPLE DR UNIT A
Practice Address - Street 2:UNIT A
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-3819
Practice Address - Country:US
Practice Address - Phone:424-249-3099
Practice Address - Fax:424-249-3099
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-30
Last Update Date:2011-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS179401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA06-1002002Medicare PIN