Mary M. Mazaheri, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

24102 Issued in CA

Practice address

312 S Cedros Ave
Ste 150
Solana Beach, CA 92075-1942

Phone

(760) 297-7335

NPI assigned

Feb 6, 2012

Last updated

Oct 12, 2018By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Other names 1

• Maryam Mehrak Mazaheri Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Apr 1, 2019 through Apr 1, 2027

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1328486400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1539302400000",
    "number": "1164794145",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1872 AVENIDA LA POSTA",
            "city": "ENCINITAS",
            "state": "CA",
            "postal_code": "920247113",
            "telephone_number": "408-513-5135"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "312 S CEDROS AVE",
            "address_2": "STE 150",
            "city": "SOLANA BEACH",
            "state": "CA",
            "postal_code": "920751942",
            "telephone_number": "760-297-7335"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MAZAHERI",
        "first_name": "MARY",
        "middle_name": "M.",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-02-06",
        "last_updated": "2018-10-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103TB0200X",
            "taxonomy_group": "",
            "desc": "Psychologist, Cognitive & Behavioral",
            "state": "CA",
            "license": "24102",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "24102",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "MARYAM",
            "last_name": "MAZAHERI",
            "middle_name": "MEHRAK",
            "credential": "PH.D.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Kaiden Maxwell, D.C.
• Lana Jessica Maxwell, PSY.D.
• Charles Francis Mayberry, L.AC.
• Tami Mayers, PHARM.D.
• Rosalily Mayorquin
• Neil Thomas McKenna, DPT
• Bryan McLeod, PT, DPT
• Michele C McNiff, RN MSN HWNC-BC AHN-B
• Robert McWhirter, M.D.
• Francesca Medina, ND

• Clinical Psychologist in Solana Beach, CA
• Providers in Solana Beach, CA by specialty
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.