Provider Demographics
NPI:1194116988
Name:BADIEE, MANIJEH (PHD)
Entity type:Individual
Prefix:
First Name:MANIJEH
Middle Name:
Last Name:BADIEE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5051 CANYON CREST DR
Mailing Address - Street 2:SUITE 204
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92507-6099
Mailing Address - Country:US
Mailing Address - Phone:951-682-1488
Mailing Address - Fax:951-682-1485
Practice Address - Street 1:5051 CANYON CREST DR
Practice Address - Street 2:SUITE 204
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92507-6099
Practice Address - Country:US
Practice Address - Phone:951-682-1488
Practice Address - Fax:951-682-1485
Is Sole Proprietor?:No
Enumeration Date:2015-02-15
Last Update Date:2015-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSB94021314103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling