Provider Demographics
NPI:1932488905
Name:SHAFAGHI, ASSADOLLAH (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ASSADOLLAH
Middle Name:
Last Name:SHAFAGHI
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1333 WILLOW PASS RD # SET102
Mailing Address - Street 2:
Mailing Address - City:CONCORD
Mailing Address - State:CA
Mailing Address - Zip Code:94520-7930
Mailing Address - Country:US
Mailing Address - Phone:925-825-1795
Mailing Address - Fax:925-825-7094
Practice Address - Street 1:1333 WILLOW PASS RD # SET102
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-7930
Practice Address - Country:US
Practice Address - Phone:707-648-8121
Practice Address - Fax:707-648-8129
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-09
Last Update Date:2018-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X, 101YM0800X, 390200000X
CA225C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No225C00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Counselor