Provider Demographics
NPI:1669841052
Name:SHAFIZADEH, ROXANNA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ROXANNA
Middle Name:
Last Name:SHAFIZADEH
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 1:12640 EUCLID ST APT 205
Mailing Address - Street 2:
Mailing Address - City:GARDEN GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:92840-5299
Mailing Address - Country:US
Mailing Address - Phone:714-206-1685
Mailing Address - Fax:
Practice Address - Street 1:18700 BEACH BLVD
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-2030
Practice Address - Country:US
Practice Address - Phone:714-206-1685
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-09-16
Last Update Date:2020-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA891461041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical