Healthcare Provider Details

I. General information

NPI: 1376453332
Provider Name (Legal Business Name): IPW LICENSED CLINICAL SOCIAL WORKER, PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2026
Last Update Date: 09/10/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23986 ALISO CREEK RD # 1046
LAGUNA NIGUEL CA
92677-3908
US

IV. Provider business mailing address

23986 ALISO CREEK RD # 1046
LAGUNA NIGUEL CA
92677-3908
US

V. Phone/Fax

Practice location:
  • Phone: 949-259-5123
  • Fax: 949-288-0358
Mailing address:
  • Phone: 949-259-5123
  • Fax: 949-288-0358

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: SHAHRZAD SHADMANI
Title or Position: PRESIDENT
Credential: NP
Phone: 949-259-5123