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General NPI Number Information
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NPI Number | 1285910109
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Entity Type | Organization
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Legal Business Name | EAST END PSYCHOLOGICAL ASSOCIATES
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Dates
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Enumeration Date | 10/24/2011
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Last Update Date | 10/24/2011
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Provider Practice Location Address
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Address Line | 6520 GLENRIDGE PARK PL SUITE #1
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City | LOUISVILLE
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State | KY
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Zip | 40222-3453
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Country | US
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Telephone | 502-426-1234
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Fax | 502-426-3388
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Provider Business Mailing Address
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Address Line | 6520 GLENRIDGE PARK PL SUITE #1
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City | LOUISVILLE
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State | KY
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Zip | 40222-3453
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Country | US
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Telephone | 502-426-1234
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Fax | 502-426-3388
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Authorized Official
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Title or Position | PRINCIPAL PARTNER
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Name | DR. KAVEH ZAMANIAN
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Credential | PHD
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Telephone | 502-426-1234
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 1592
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 3446
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License Number State | KY
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 3429
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License Number State | KY
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Taxonomy #4
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 1520
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License Number State | KY
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