Individual
DR. HEIDAR A. MODARESI
Active
Individual
DR. HEIDAR A. MODARESI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PHD
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
0575
SC
101YM0800X
Mental Health Counselor
1973
NC
103T00000X
Psychologist
0575
SC
103T00000X
Psychologist
1973
NC
103TB0200X
Cognitive & Behavioral Psychologist
0575
SC
103TB0200X
Cognitive & Behavioral Psychologist
1973
NC
103TC0700X
Clinical Psychologist
Primary
0575
SC
103TC0700X
Clinical Psychologist
1973
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PS0221
—
SC
Enumeration date
05/18/2006
Last updated
09/02/2010
Update your record
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