Provider Demographics
NPI:1801178843
Name:IZADI, FARANAK FARA (LCSW)
Entity Type:Individual
Prefix:MISS
First Name:FARANAK
Middle Name:FARA
Last Name:IZADI
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:FARANAK
Other - Middle Name:FARA
Other - Last Name:SHAHINFAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 853
Mailing Address - Street 2:
Mailing Address - City:LAKEPORT
Mailing Address - State:CA
Mailing Address - Zip Code:95453-0853
Mailing Address - Country:US
Mailing Address - Phone:818-523-1576
Mailing Address - Fax:
Practice Address - Street 1:1024 IRON POINT RD
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-8013
Practice Address - Country:US
Practice Address - Phone:818-523-1576
Practice Address - Fax:916-673-9545
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-15
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
CAASW63031101YM0800X
CA804751041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health