Provider Demographics
NPI:1841601473
Name:SOUTH BAY CHILD AND FAMILY THERAPY, INC.
Entity Type:Organization
Organization Name:SOUTH BAY CHILD AND FAMILY THERAPY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL PSYCHOLOGIST/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAHRZAD
Authorized Official - Middle Name:M
Authorized Official - Last Name:GITI
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:424-888-4484
Mailing Address - Street 1:1601 PACIFIC COAST HWY STE 290
Mailing Address - Street 2:
Mailing Address - City:HERMOSA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90254-3283
Mailing Address - Country:US
Mailing Address - Phone:424-888-4484
Mailing Address - Fax:
Practice Address - Street 1:1601 PACIFIC COAST HWY STE 290
Practice Address - Street 2:
Practice Address - City:HERMOSA BEACH
Practice Address - State:CA
Practice Address - Zip Code:90254-3283
Practice Address - Country:US
Practice Address - Phone:424-888-4484
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-16
Last Update Date:2014-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY26369103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty