Provider Demographics
NPI:1962533950
Name:SIADAT, VAHEED (MFT INTERN)
Entity type:Individual
Prefix:MR
First Name:VAHEED
Middle Name:
Last Name:SIADAT
Suffix:
Gender:M
Credentials:MFT INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1812 BUTLER AVE APT 4
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-5476
Mailing Address - Country:US
Mailing Address - Phone:310-914-9245
Mailing Address - Fax:310-914-9245
Practice Address - Street 1:1812 BUTLER AVE APT 4
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-5476
Practice Address - Country:US
Practice Address - Phone:310-914-9245
Practice Address - Fax:310-914-9245
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist