Provider Demographics
NPI:1992295539
Name:CHITSAZ, SEPIDEH
Entity type:Individual
Prefix:
First Name:SEPIDEH
Middle Name:
Last Name:CHITSAZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4141 N HENDERSON RD STE 8
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22203-2485
Mailing Address - Country:US
Mailing Address - Phone:571-777-9210
Mailing Address - Fax:
Practice Address - Street 1:7513 MARBURY RD
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:MD
Practice Address - Zip Code:20817-6222
Practice Address - Country:US
Practice Address - Phone:240-918-8675
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-17
Last Update Date:2018-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician