MEDICARE: JANIA AMIR-RAZAVI PSYD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor
2	103TC0700X	Clinical Psychologist	39126	TX

General Provider Information

NPI Number	:	1649402470
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JANIA AMIR-RAZAVI PSYD

Provider Business Mailing Address
First Line	:	7272 WURZBACH RD STE 706
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78240-4803
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4004 SHORES CT
Second Line	:
City	:	ARLINGTON
State	:	TX
Zip	:	76016-4241
Country	:	US
Telephone Number	:	858-209-1288
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/12/2009
Last Update Date	:	01/19/2022

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