Healthcare Provider Details

I. General information

NPI: 1245527035
Provider Name (Legal Business Name): PARIVASH MINOU MICHLIN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: PARIVASH SOUMEKH DSW

II. Dates (important events)

Enumeration Date: 06/30/2011
Last Update Date: 06/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 N MAPLE DR UNIT A UNIT A
BEVERLY HILLS CA
90210-3819
US

IV. Provider business mailing address

412 N MAPLE DR UNIT A UNIT A
BEVERLY HILLS CA
90210-3819
US

V. Phone/Fax

Practice location:
  • Phone: 424-249-3099
  • Fax: 424-249-3099
Mailing address:
  • Phone: 424-249-3099
  • Fax: 424-249-3099

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS17940
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: