Provider Demographics
NPI:1447923693
Name:TAGHDIMI, MARYAM (PHD)
Entity type:Individual
Prefix:DR
First Name:MARYAM
Middle Name:
Last Name:TAGHDIMI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 JUNIPERO SERRA BLVD STE 650
Mailing Address - Street 2:
Mailing Address - City:DALY CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94014-3897
Mailing Address - Country:US
Mailing Address - Phone:650-754-5633
Mailing Address - Fax:
Practice Address - Street 1:2001 JUNIPERO SERRA BLVD STE 650
Practice Address - Street 2:
Practice Address - City:DALY CITY
Practice Address - State:CA
Practice Address - Zip Code:94014-3897
Practice Address - Country:US
Practice Address - Phone:650-646-5633
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-25
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32683103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist