Provider Demographics
NPI:1083079586
Name:SHANI HABIBI PHD INC A PSYCHOLOGICAL CORPORATION
Entity Type:Organization
Organization Name:SHANI HABIBI PHD INC A PSYCHOLOGICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAGHAYEGH 'SHANI'
Authorized Official - Middle Name:
Authorized Official - Last Name:HABIBI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:818-307-6020
Mailing Address - Street 1:16661 VENTURA BLVD #226A
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-3334
Mailing Address - Country:US
Mailing Address - Phone:818-307-6020
Mailing Address - Fax:
Practice Address - Street 1:16661 VENTURA BLVD #226A
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-3334
Practice Address - Country:US
Practice Address - Phone:818-307-6020
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-28
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA26779103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty