Healthcare Provider Details

I. General information

NPI: 1619004322
Provider Name (Legal Business Name): FARSHID AFSARIFARD PH.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: FARSHID AFSARIFARD PH.D.

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 01/31/2020
Certification Date: 01/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8701 MENTOR AVE
MENTOR OH
44060-6103
US

IV. Provider business mailing address

8701 MENTOR AVE
MENTOR OH
44060-6103
US

V. Phone/Fax

Practice location:
  • Phone: 440-266-0770
  • Fax: 440-266-0257
Mailing address:
  • Phone: 440-266-0770
  • Fax: 440-266-0257

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6237
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: