Healthcare Provider Details

I. General information

NPI: 1457279499
Provider Name (Legal Business Name): BEHNOUSH KHAFAJIZADEH, LICENSED CLINICAL SOCIAL WORKER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 07/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1342 ALESSANDRO DR
THOUSAND OAKS CA
91320-3531
US

IV. Provider business mailing address

8549 WILSHIRE BLVD # 2522
BEVERLY HILLS CA
90211-3104
US

V. Phone/Fax

Practice location:
  • Phone: 818-390-3585
  • Fax:
Mailing address:
  • Phone: 818-390-3585
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State

VIII. Authorized Official

Name: MS. BEHNOUSH KHAFAJIZADEH
Title or Position: THERAPIST/ PRESIDENT
Credential: LCSW
Phone: 818-390-3585