Healthcare Provider Details

I. General information

NPI: 1700359668
Provider Name (Legal Business Name): SHIREEN FARSI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/03/2019
Last Update Date: 10/07/2024
Certification Date: 10/07/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 1329
SAN CARLOS CA
94070-7329
US

IV. Provider business mailing address

4300 BLACK AVE UNIT 1004
PLEASANTON CA
94566-5048
US

V. Phone/Fax

Practice location:
  • Phone: 650-814-7601
  • Fax: 650-817-9074
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number94596
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: