Provider Demographics
NPI:1053855783
Name:CAROLINE DARAVI
Entity Type:Organization
Organization Name:CAROLINE DARAVI
Other - Org Name:(DBA) HERA COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:CAROLINE
Authorized Official - Middle Name:
Authorized Official - Last Name:DARAVI
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:909-553-2573
Mailing Address - Street 1:1706 PLUM LANE #110
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92374
Mailing Address - Country:US
Mailing Address - Phone:909-553-2573
Mailing Address - Fax:909-677-4883
Practice Address - Street 1:1706 PLUM LANE #110
Practice Address - Street 2:
Practice Address - City:REDLAND
Practice Address - State:CA
Practice Address - Zip Code:92374
Practice Address - Country:US
Practice Address - Phone:909-553-2573
Practice Address - Fax:909-677-4883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-14
Last Update Date:2019-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty