Healthcare Provider Details

I. General information

NPI: 1265948202
Provider Name (Legal Business Name): SHABNAM SHARIFI LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2017
Last Update Date: 05/04/2026
Certification Date: 05/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 EXECUTIVE PARK BLVD STE 4900
SAN FRANCISCO CA
94134-3335
US

IV. Provider business mailing address

250 EXECUTIVE PARK BLVD STE 4900
SAN FRANCISCO CA
94134-3335
US

V. Phone/Fax

Practice location:
  • Phone: 415-656-0116
  • Fax:
Mailing address:
  • Phone: 415-656-0116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number121122
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: