Individual
DR. FATEMEH AHDI BANI-TABA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PSYD
Contact information
Practice address
401 BICENTENNIAL WAY, MOB EAST, SANTA ROSA, CA 95403-2149
(707) 571-5181
(707) 571-4110
Mailing address
PO BOX 6747, SANTA ROSA, CA 95406-0747
(707) 571-5181
(707) 571-4110
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PSY18968
CA
Other
Enumeration date
08/27/2007
Last updated
08/27/2007
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