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Individual

DR. AVID G FARAHANI

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PSYD

Contact information

Practice address
10260 SW GREENBURG RD STE 400, PORTLAND, OR 97223-5514
(503) 575-1317
(503) 388-4144
Mailing address
18946 TUBA ST, NORTHRIDGE, CA 91324-1230
(503) 575-1317
(503) 388-4144

Taxonomy

Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
2166
OR
103TC0700X
Clinical Psychologist
PSY23456
CA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
500633704
OR
Enumeration date
11/06/2008
Last updated
05/23/2022
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