Provider Demographics
NPI:1316968076
Name:GHAFFARIAN, SHIREEN G (PHD)
Entity type:Individual
Prefix:
First Name:SHIREEN
Middle Name:G
Last Name:GHAFFARIAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9300 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 320
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-3213
Mailing Address - Country:US
Mailing Address - Phone:310-289-2102
Mailing Address - Fax:310-399-1493
Practice Address - Street 1:9300 WILSHIRE BLVD
Practice Address - Street 2:SUITE 320
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-3213
Practice Address - Country:US
Practice Address - Phone:310-289-2102
Practice Address - Fax:310-399-1493
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY12497103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist