Provider Demographics
NPI:1285910109
Name:EAST END PSYCHOLOGICAL ASSOCIATES
Entity type:Organization
Organization Name:EAST END PSYCHOLOGICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KAVEH
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAMANIAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:502-426-1234
Mailing Address - Street 1:6520 GLENRIDGE PARK PL
Mailing Address - Street 2:SUITE #1
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-3453
Mailing Address - Country:US
Mailing Address - Phone:502-426-1234
Mailing Address - Fax:502-426-3388
Practice Address - Street 1:6520 GLENRIDGE PARK PL
Practice Address - Street 2:SUITE #1
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222-3453
Practice Address - Country:US
Practice Address - Phone:502-426-1234
Practice Address - Fax:502-426-3388
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-10-24
Last Update Date:2011-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1520103TC0700X
KY1592103TC0700X
KY34461041C0700X
KY34291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty