Provider Demographics
NPI:1053033985
Name:PANAHANDEH, NEDA (MA)
Entity type:Individual
Prefix:
First Name:NEDA
Middle Name:
Last Name:PANAHANDEH
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1079 SUNRISE AVE STE B-244
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-7009
Mailing Address - Country:US
Mailing Address - Phone:925-338-1430
Mailing Address - Fax:
Practice Address - Street 1:790 E COLORADO BLVD FL 9
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-2193
Practice Address - Country:US
Practice Address - Phone:626-354-6440
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-16
Last Update Date:2024-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TB0200X, 103TC2200X, 103TM1800X, 390200000X
CAPSY32742103TC0700X
CAPSB94026957103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & BehavioralGroup - Single Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program