MEDICARE: DR. AMIR MAHDAVI PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	020974	NY
2	103TC0700X	Clinical Psychologist	PSY30512	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396057550
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. AMIR MAHDAVI PH.D.

Provider Business Mailing Address
First Line	:	PO BOX 4403
Second Line	:
City	:	WEST HILLS
State	:	CA
Zip	:	91308-4403
Country	:	US
Telephone Number	:	818-917-7773
Fax Number	:

Provider Business Practice Location Address
First Line	:	15456 VENTURA BLVD STE 500
Second Line	:
City	:	SHERMAN OAKS
State	:	CA
Zip	:	91403-3023
Country	:	US
Telephone Number	:	818-917-7773
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/04/2010
Last Update Date	:	04/07/2021

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