Provider Demographics
NPI:1669057964
Name:AFSHAR, SHABNAM (LMFT 106344)
Entity type:Individual
Prefix:
First Name:SHABNAM
Middle Name:
Last Name:AFSHAR
Suffix:
Gender:F
Credentials:LMFT 106344
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1219 VIRGINIA AVE
Mailing Address - Street 2:
Mailing Address - City:CAMPBELL
Mailing Address - State:CA
Mailing Address - Zip Code:95008-6808
Mailing Address - Country:US
Mailing Address - Phone:408-921-8302
Mailing Address - Fax:
Practice Address - Street 1:515 E CAMPBELL AVE
Practice Address - Street 2:STE #220
Practice Address - City:CAMPBELL
Practice Address - State:CA
Practice Address - Zip Code:95008-9500
Practice Address - Country:US
Practice Address - Phone:408-412-3674
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-17
Last Update Date:2021-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA106344106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty