Provider Demographics
NPI:1457587826
Name:DARAVI, CAROLINE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CAROLINE
Middle Name:
Last Name:DARAVI
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1706 PLUM LN STE 110
Mailing Address - Street 2:
Mailing Address - City:REDLANDS
Mailing Address - State:CA
Mailing Address - Zip Code:92374-4578
Mailing Address - Country:US
Mailing Address - Phone:909-553-2573
Mailing Address - Fax:
Practice Address - Street 1:1706 PLUM LN STE 110
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92374-4578
Practice Address - Country:US
Practice Address - Phone:909-553-2573
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-29
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA22676103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist