Healthcare Provider Details

I. General information

NPI: 1295385433
Provider Name (Legal Business Name): SETAREH VATAN MA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2019
Last Update Date: 06/04/2025
Certification Date: 06/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4774 PARK GRANADA UNIT 9024
CALABASAS CA
91372-7049
US

IV. Provider business mailing address

4774 PARK GRANADA UNIT 9024
CALABASAS CA
91372-7049
US

V. Phone/Fax

Practice location:
  • Phone: 818-851-1395
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number140813
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: