Individual
ALI KHADIVI
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PH.D.
Contact information
Practice address
1276 FULTON AVE, 4 SOUTH, BRONX, NY 10456-3402
(718) 901-8889
(718) 466-6060
Mailing address
210 W 101ST ST, PH-10, NEW YORK, NY 10025-5059
(212) 662-4704
(212) 662-4704
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
011060-1
NY
Other
Enumeration date
03/07/2007
Last updated
07/08/2007
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