Provider Demographics
NPI:1154718799
Name:SHAHRYARINEJAD, AZADEH (MS, LMFT, MS, LM)
Entity type:Individual
Prefix:MRS
First Name:AZADEH
Middle Name:
Last Name:SHAHRYARINEJAD
Suffix:
Gender:F
Credentials:MS, LMFT, MS, LM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2606 FERRARA ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89044-1797
Mailing Address - Country:US
Mailing Address - Phone:585-455-3407
Mailing Address - Fax:
Practice Address - Street 1:2606 FERRARA ST
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89044-1797
Practice Address - Country:US
Practice Address - Phone:585-751-3511
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-21
Last Update Date:2023-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY094183-1104100000X
NV8813-S104100000X
NV3193-R106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No104100000XBehavioral Health & Social Service ProvidersSocial Worker