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General NPI Number Information
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NPI Number | 1699388892
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Entity Type | Individual
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Provider Name | DAMON POURTAHMASEB-SASI LMFT
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Gender | Male
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Dates
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Enumeration Date | 08/26/2020
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Last Update Date | 08/26/2020
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Provider Practice Location Address
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Address Line | 761 NE 199TH ST APT 204
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City | MIAMI
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State | FL
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Zip | 33179-3067
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Country | US
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Telephone | 786-271-4868
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Fax |
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Provider Business Mailing Address
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Address Line | 761 NE 199TH ST APT 204
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City | MIAMI
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State | FL
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Zip | 33179-3067
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Country | US
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Telephone | 786-271-4868
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | MT3419
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License Number State | FL
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