Healthcare Provider Details

I. General information

NPI: 1215381538
Provider Name (Legal Business Name): SHAHRZAD AZARAFZA LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SHAY AZARAFZA LCSW

II. Dates (important events)

Enumeration Date: 04/22/2016
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19712 MACARTHUR BLVD STE 110
IRVINE CA
92612-2407
US

IV. Provider business mailing address

19712 MACARTHUR BLVD STE 110
IRVINE CA
92612-2407
US

V. Phone/Fax

Practice location:
  • Phone: 714-406-0454
  • Fax:
Mailing address:
  • Phone: 714-406-0454
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number101928
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: