Provider Demographics
NPI:1306961933
Name:LOVELACE, ANAHITA NAFICY (PHD)
Entity type:Individual
Prefix:DR
First Name:ANAHITA
Middle Name:NAFICY
Last Name:LOVELACE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:ANAHITA
Other - Middle Name:
Other - Last Name:NAFICY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:2831 MEDILL PL
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90064-4643
Mailing Address - Country:US
Mailing Address - Phone:310-836-9150
Mailing Address - Fax:
Practice Address - Street 1:2831 MEDILL PL
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90064-4643
Practice Address - Country:US
Practice Address - Phone:310-836-9150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY8290103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY8290OtherCA BOARD OF PSYCHOLOGY LI
CACP8290Medicare PIN