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NPI Code Detail

MEDICARE: MS. SHARAREH - GHEDARI MFT LICENSED

MEDICARE: MS. SHARAREH - GHEDARI MFT LICENSED
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106H00000XMarriage & Family TherapistMFC42028CA

General Provider Information

NPI Number : 1487787784
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. SHARAREH - GHEDARI MFT LICENSED
Provider Business Mailing Address
First Line : P.O. BOX 1846
Second Line :
City : AGOURA HILLS
State : CA
Zip : 91376-1846
Country : US
Telephone Number : 818-889-1190
Fax Number :
Provider Business Practice Location Address
First Line : 4900 SERRANIA AVE
Second Line :
City : WOODLAND HILLS
State : CA
Zip : 91364-3301
Country : US
Telephone Number : 818-657-3109
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/14/2007
Last Update Date : 07/08/2007

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