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General NPI Number Information
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NPI Number | 1710349360
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Entity Type | Individual
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Provider Name | NAAZGOL ESHTEHARDI M.A., ED.M., LMHC
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Gender | Female
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Dates
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Enumeration Date | 03/23/2016
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Last Update Date | 03/21/2017
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Provider Practice Location Address
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Address Line | 14 PENN PLZ FRNT 4
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City | NEW YORK
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State | NY
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Zip | 10122-0003
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Country | US
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Telephone | 323-213-3037
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Fax |
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Provider Business Mailing Address
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Address Line | 687 DRIGGS AVE APT 3N
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City | BROOKLYN
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State | NY
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Zip | 11211-4005
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Country | US
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Telephone | 917-426-1363
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 007100
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License Number State | NY
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