Provider Demographics
NPI:1164612628
Name:SHAHVARIAN, SHIDEH (MA LMFT)
Entity Type:Individual
Prefix:
First Name:SHIDEH
Middle Name:
Last Name:SHAHVARIAN
Suffix:
Gender:F
Credentials:MA LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:980 W WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94086-5904
Mailing Address - Country:US
Mailing Address - Phone:510-921-0907
Mailing Address - Fax:408-732-1358
Practice Address - Street 1:980 W WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94086-5904
Practice Address - Country:US
Practice Address - Phone:510-921-0907
Practice Address - Fax:408-732-1358
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-30
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 51557106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist