Provider Demographics
NPI:1972770899
Name:SAFVATI, NEDA (PSYD)
Entity type:Individual
Prefix:DR
First Name:NEDA
Middle Name:
Last Name:SAFVATI
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:NEDA
Other - Middle Name:SAFVATI
Other - Last Name:WEDEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:12522 MOORPARK ST STE 106
Mailing Address - Street 2:
Mailing Address - City:STUDIO CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91604-1355
Mailing Address - Country:US
Mailing Address - Phone:818-661-6306
Mailing Address - Fax:818-666-0221
Practice Address - Street 1:12522 MOORPARK ST STE 106
Practice Address - Street 2:
Practice Address - City:STUDIO CITY
Practice Address - State:CA
Practice Address - Zip Code:91604-1355
Practice Address - Country:US
Practice Address - Phone:818-661-6306
Practice Address - Fax:818-666-0221
Is Sole Proprietor?:No
Enumeration Date:2008-05-09
Last Update Date:2019-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 25346103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1855VDEMMedicaid