Provider Demographics
NPI:1245996768
Name:ALIVERDI, SHIRIN
Entity type:Individual
Prefix:
First Name:SHIRIN
Middle Name:
Last Name:ALIVERDI
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27762 ANTONIO PARKWAY, STE L-1, 315
Mailing Address - Street 2:
Mailing Address - City:LADERA RANCH
Mailing Address - State:CA
Mailing Address - Zip Code:92694
Mailing Address - Country:US
Mailing Address - Phone:949-777-5015
Mailing Address - Fax:
Practice Address - Street 1:27762 ANTONIO PARKWAY, STE L-1, 315
Practice Address - Street 2:
Practice Address - City:LADERA RANCH
Practice Address - State:CA
Practice Address - Zip Code:92694-9269
Practice Address - Country:US
Practice Address - Phone:949-777-5015
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-09
Last Update Date:2025-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA153251106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist