Provider Demographics
NPI:1215381538
Name:AZARAFZA, SHAHRZAD (LCSW)
Entity Type:Individual
Prefix:
First Name:SHAHRZAD
Middle Name:
Last Name:AZARAFZA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:SHAY
Other - Middle Name:
Other - Last Name:AZARAFZA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:2575 MCCABE WAY STE 230
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92614-4241
Mailing Address - Country:US
Mailing Address - Phone:714-406-0454
Mailing Address - Fax:714-406-0616
Practice Address - Street 1:2575 MCCABE WAY STE 230
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92614-4241
Practice Address - Country:US
Practice Address - Phone:714-406-0454
Practice Address - Fax:714-406-0616
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-22
Last Update Date:2022-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101928101YM0800X
ASW77817101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1215381538Medicaid