Healthcare Provider Details

I. General information

NPI: 1124530365
Provider Name (Legal Business Name): SHABNAM JANANI LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/27/2017
Last Update Date: 08/03/2022
Certification Date: 08/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3572 ERIS CT
WALNUT CREEK CA
94598-4669
US

IV. Provider business mailing address

3572 ERIS CT
WALNUT CREEK CA
94598-4669
US

V. Phone/Fax

Practice location:
  • Phone: 650-382-8238
  • Fax:
Mailing address:
  • Phone: 650-382-8238
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number87038
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: