Provider Demographics
NPI:1558378844
Name:KAMALI, SHAHNAZ (LCSW)
Entity Type:Individual
Prefix:
First Name:SHAHNAZ
Middle Name:
Last Name:KAMALI
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:102 POWDERLY CT
Mailing Address - Street 2:
Mailing Address - City:FOLSOM
Mailing Address - State:CA
Mailing Address - Zip Code:95630-5247
Mailing Address - Country:US
Mailing Address - Phone:916-985-2460
Mailing Address - Fax:
Practice Address - Street 1:10013 FOLSOM BLVD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95827
Practice Address - Country:US
Practice Address - Phone:916-875-8694
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2019-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW21508104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
CALCS21508OtherLCSW