Provider Demographics
NPI:1841484227
Name:HABIBI, SHAGHAYEGH SHANI (PHD)
Entity type:Individual
Prefix:DR
First Name:SHAGHAYEGH
Middle Name:SHANI
Last Name:HABIBI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:SHANI
Other - Middle Name:
Other - Last Name:HABIBI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHD
Mailing Address - Street 1:6521 WYSTONE AVE UNIT 6
Mailing Address - Street 2:
Mailing Address - City:RESEDA
Mailing Address - State:CA
Mailing Address - Zip Code:91335-7611
Mailing Address - Country:US
Mailing Address - Phone:818-307-6020
Mailing Address - Fax:
Practice Address - Street 1:6521 WYSTONE AVE UNIT 6
Practice Address - Street 2:
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-7611
Practice Address - Country:US
Practice Address - Phone:818-307-6020
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-29
Last Update Date:2024-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103TB0200X, 103TC2200X
CAPSY26779103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent