Provider Demographics
NPI:1285187963
Name:SHAHBAZIAN, MARY RHODA (MS)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:RHODA
Last Name:SHAHBAZIAN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:355 TUOLUMNE ST
Mailing Address - Street 2:
Mailing Address - City:VALLEJO
Mailing Address - State:CA
Mailing Address - Zip Code:94590-5700
Mailing Address - Country:US
Mailing Address - Phone:707-553-5219
Mailing Address - Fax:707-553-5653
Practice Address - Street 1:355 TUOLUMNE ST
Practice Address - Street 2:
Practice Address - City:VALLEJO
Practice Address - State:CA
Practice Address - Zip Code:94590-5700
Practice Address - Country:US
Practice Address - Phone:707-553-5219
Practice Address - Fax:707-553-5653
Is Sole Proprietor?:No
Enumeration Date:2016-07-28
Last Update Date:2023-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker
No101Y00000XBehavioral Health & Social Service ProvidersCounselor