Provider Demographics
NPI:1851858708
Name:TABRIZI, SYAMAK HAKIMI (LCSW, CATC IV)
Entity type:Individual
Prefix:
First Name:SYAMAK
Middle Name:HAKIMI
Last Name:TABRIZI
Suffix:
Gender:M
Credentials:LCSW, CATC IV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9712 SAINT GEORGE ST
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91977-5248
Mailing Address - Country:US
Mailing Address - Phone:760-990-3747
Mailing Address - Fax:
Practice Address - Street 1:5101 MARKET ST STE 2300
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92114-2225
Practice Address - Country:US
Practice Address - Phone:858-351-6000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-27
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
CA199584101YA0400X
CA96334101YM0800X
CALCSW1217341041C0700X
CAASW96334104100000X, 390200000X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program