Provider Demographics
NPI:1629391545
Name:SHAROKHI, BANAFSHE PATRICIA (PHD, QME)
Entity Type:Individual
Prefix:DR
First Name:BANAFSHE
Middle Name:PATRICIA
Last Name:SHAROKHI
Suffix:
Gender:F
Credentials:PHD, QME
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5333 BALBOA BLVD
Mailing Address - Street 2:APT. #134
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-2813
Mailing Address - Country:US
Mailing Address - Phone:818-201-6194
Mailing Address - Fax:818-340-1207
Practice Address - Street 1:21031 VENTURA BLVD
Practice Address - Street 2:SUITE 507
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-2203
Practice Address - Country:US
Practice Address - Phone:818-201-6194
Practice Address - Fax:818-340-1207
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-05
Last Update Date:2012-02-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPSY 23369103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical