Provider Demographics
NPI:1811640931
Name:JARAHZADEH, AUDREY SOPHIA (LCSW)
Entity type:Individual
Prefix:
First Name:AUDREY
Middle Name:SOPHIA
Last Name:JARAHZADEH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:AUDREY
Other - Middle Name:SOPHIA
Other - Last Name:JARAHZADEH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FABRE
Mailing Address - Street 1:9740 CAMPO RD STE 1015
Mailing Address - Street 2:
Mailing Address - City:SPRING VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:91977-1415
Mailing Address - Country:US
Mailing Address - Phone:310-770-2431
Mailing Address - Fax:
Practice Address - Street 1:1901 1ST AVE STE 104
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92101-0300
Practice Address - Country:US
Practice Address - Phone:310-770-2431
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-28
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA803911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical