Provider Demographics
NPI:1598192098
Name:FARIBA SHARIFI PSYCHOLOGICAL CORP.
Entity Type:Organization
Organization Name:FARIBA SHARIFI PSYCHOLOGICAL CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:MS
Authorized Official - First Name:FARIBA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHARIFI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-620-6646
Mailing Address - Street 1:6399 WILSHIRE BLVD STE 1016
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-5713
Mailing Address - Country:US
Mailing Address - Phone:818-620-6646
Mailing Address - Fax:
Practice Address - Street 1:6399 WILSHIRE BLVD STE 1016
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-5713
Practice Address - Country:US
Practice Address - Phone:818-620-6646
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-30
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY25212103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty