MEDICARE: MISS FARANAK FARA IZADI LCSW

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
1	101YM0800X	Mental Health Counselor
2	1041C0700X	Clinical Social Worker	80475	CA
3	101YM0800X	Mental Health Counselor	ASW63031	CA

General Provider Information

NPI Number	:	1801178843
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS FARANAK FARA IZADI LCSW

Provider Business Mailing Address
First Line	:	8146 GREENBACK LN BLDG 3
Second Line	:
City	:	FAIR OAKS
State	:	CA
Zip	:	95628-2551
Country	:	US
Telephone Number	:	818-523-1576
Fax Number	:

Provider Business Practice Location Address
First Line	:	8146 GREENBACK LN BLDG 3
Second Line	:
City	:	FAIR OAKS
State	:	CA
Zip	:	95628-2551
Country	:	US
Telephone Number	:	818-523-1576
Fax Number	:	916-673-9545

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/15/2011
Last Update Date	:	05/21/2026

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