Provider Demographics
NPI:1124334917
Name:SHAHVERDIYEVA, CAROLINA (BA, BS)
Entity type:Individual
Prefix:
First Name:CAROLINA
Middle Name:
Last Name:SHAHVERDIYEVA
Suffix:
Gender:F
Credentials:BA, BS
Other - Prefix:
Other - First Name:CAROLINA
Other - Middle Name:
Other - Last Name:MOJICA-LOPEZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CFAAP RS 6514
Mailing Address - Street 1:957 INDUSTRIAL RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:SAN CARLOS
Mailing Address - State:CA
Mailing Address - Zip Code:94070-4151
Mailing Address - Country:US
Mailing Address - Phone:650-832-6791
Mailing Address - Fax:650-620-9549
Practice Address - Street 1:957 INDUSTRIAL RD
Practice Address - Street 2:SUITE B
Practice Address - City:SAN CARLOS
Practice Address - State:CA
Practice Address - Zip Code:94070-4151
Practice Address - Country:US
Practice Address - Phone:650-832-6791
Practice Address - Fax:650-620-9549
Is Sole Proprietor?:No
Enumeration Date:2010-08-31
Last Update Date:2015-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No172V00000XOther Service ProvidersCommunity Health Worker