Provider Demographics
NPI:1548529498
Name:ZARBAKHSH, LEILI
Entity type:Individual
Prefix:
First Name:LEILI
Middle Name:
Last Name:ZARBAKHSH
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 1:9501 OAKDALE AVE
Mailing Address - Street 2:
Mailing Address - City:CHATSWORTH
Mailing Address - State:CA
Mailing Address - Zip Code:91311-5625
Mailing Address - Country:US
Mailing Address - Phone:805-339-0210
Mailing Address - Fax:805-642-3757
Practice Address - Street 1:9201 OAKDALE AVE
Practice Address - Street 2:
Practice Address - City:CHATSWORTH
Practice Address - State:CA
Practice Address - Zip Code:91311-6542
Practice Address - Country:US
Practice Address - Phone:805-339-0210
Practice Address - Fax:805-642-3757
Is Sole Proprietor?:No
Enumeration Date:2012-05-13
Last Update Date:2019-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-04-1816103K00000X
CALEP1844103TS0200X
CA24726106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1-04-1816OtherBCBA CERTIFICATE