Healthcare Provider Details

I. General information

NPI: 1629395546
Provider Name (Legal Business Name): HELEYA RAD PSY.D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2010
Last Update Date: 02/13/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2 N LAKE AVE STE 800
PASADENA CA
91101-1858
US

IV. Provider business mailing address

2 N LAKE AVE STE 800
PASADENA CA
91101-1858
US

V. Phone/Fax

Practice location:
  • Phone: 646-449-2484
  • Fax: 626-449-1107
Mailing address:
  • Phone: 646-449-2484
  • Fax: 626-449-1107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPSY27849
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: