Basic Information
| Provider Information | |||||||||
| NPI: | 1760119150 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BAGHERI | ||||||||
| FirstName: | ROJAN | ||||||||
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| Credential: | DOCTORAL CANDIDATE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9121 COLBERG DR | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787494154 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5128254164 | ||||||||
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| Practice Location | |||||||||
| Address1: | 409 W BROADWAY | ||||||||
| Address2: | |||||||||
| City: | BOSTON | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021272245 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6172697500 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/04/2022 | ||||||||
| LastUpdateDate: | 08/04/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/04/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TH0100X | N | Behavioral Health & Social Service Providers | Psychologist | Health Service | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.