Basic Information
| Provider Information | |||||||||
| NPI: | 1962700153 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHAFIEZADEH | ||||||||
| FirstName: | HAMID | ||||||||
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| Credential: | MFTI | ||||||||
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| Mailing Information | |||||||||
| Address1: | 544 INTERNATIONAL BLVD APT 9 | ||||||||
| Address2: | |||||||||
| City: | OAKLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 946062973 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5104441671 | ||||||||
| FaxNumber: | 5104444283 | ||||||||
| Practice Location | |||||||||
| Address1: | 544 INTERNATIONAL BLVD APT 9 | ||||||||
| Address2: | |||||||||
| City: | OAKLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 946062973 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5104441671 | ||||||||
| FaxNumber: | 5104444283 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/11/2011 | ||||||||
| LastUpdateDate: | 03/11/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | IMF57702 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.