Provider Demographics
NPI:1710513247
Name:GAJDOSIK, MIA (LCSW, MPH, MS)
Entity type:Individual
Prefix:
First Name:MIA
Middle Name:
Last Name:GAJDOSIK
Suffix:
Gender:F
Credentials:LCSW, MPH, MS
Other - Prefix:
Other - First Name:FATEMEH
Other - Middle Name:
Other - Last Name:ADLPARVAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW, MPH, MS
Mailing Address - Street 1:22882 UPLAND WAY
Mailing Address - Street 2:
Mailing Address - City:HAYWARD
Mailing Address - State:CA
Mailing Address - Zip Code:94541-3344
Mailing Address - Country:US
Mailing Address - Phone:781-439-7132
Mailing Address - Fax:
Practice Address - Street 1:22882 UPLAND WAY
Practice Address - Street 2:
Practice Address - City:HAYWARD
Practice Address - State:CA
Practice Address - Zip Code:94541-3344
Practice Address - Country:US
Practice Address - Phone:781-439-7132
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-03-16
Last Update Date:2025-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY097626104100000X
CA1279401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker