Healthcare Provider Details

I. General information

NPI: 1801178843
Provider Name (Legal Business Name): FARANAK FARA IZADI LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: FARANAK FARA SHAHINFAR

II. Dates (important events)

Enumeration Date: 09/15/2011
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8146 GREENBACK LN BLDG 3
FAIR OAKS CA
95628-2551
US

IV. Provider business mailing address

8146 GREENBACK LN BLDG 3
FAIR OAKS CA
95628-2551
US

V. Phone/Fax

Practice location:
  • Phone: 818-523-1576
  • Fax: 916-673-9545
Mailing address:
  • Phone: 818-523-1576
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number80475
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberASW63031
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: