Provider Demographics
NPI:1942759824
Name:NASSIRI, MARZIEH
Entity type:Individual
Prefix:
First Name:MARZIEH
Middle Name:
Last Name:NASSIRI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 16836
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91416-6836
Mailing Address - Country:US
Mailing Address - Phone:818-621-1664
Mailing Address - Fax:
Practice Address - Street 1:10200 SEPULVEDA BLVD
Practice Address - Street 2:SUITE 180
Practice Address - City:MISSION HILLS
Practice Address - State:CA
Practice Address - Zip Code:91345-2649
Practice Address - Country:US
Practice Address - Phone:818-621-1664
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-03
Last Update Date:2016-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA94559106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist