Healthcare Provider Details

I. General information

NPI: 1053033985
Provider Name (Legal Business Name): NEDA PANAHANDEH MA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2022
Last Update Date: 04/30/2024
Certification Date: 04/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

790 E COLORADO BLVD FL 9
PASADENA CA
91101-2193
US

IV. Provider business mailing address

1079 SUNRISE AVE STE B-244
ROSEVILLE CA
95661-7009
US

V. Phone/Fax

Practice location:
  • Phone: 626-354-6440
  • Fax:
Mailing address:
  • Phone: 925-338-1430
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY32742
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSB94026957
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: