Provider Demographics
NPI:1265281653
Name:NAZARIAN, DESIREE
Entity type:Individual
Prefix:
First Name:DESIREE
Middle Name:
Last Name:NAZARIAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 WEST AVE PH 29
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33139-4377
Mailing Address - Country:US
Mailing Address - Phone:201-618-8834
Mailing Address - Fax:
Practice Address - Street 1:1521 ALTON RD STE 211
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33139-3301
Practice Address - Country:US
Practice Address - Phone:201-618-8834
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-16
Last Update Date:2024-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW231011041C0700X
NY0972591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical