Provider Demographics
NPI:1770935751
Name:RAZAWI, SHABNAM (MA)
Entity type:Individual
Prefix:
First Name:SHABNAM
Middle Name:
Last Name:RAZAWI
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2120 IBERIS CT
Mailing Address - Street 2:
Mailing Address - City:TRACY
Mailing Address - State:CA
Mailing Address - Zip Code:95376-9219
Mailing Address - Country:US
Mailing Address - Phone:925-594-0908
Mailing Address - Fax:
Practice Address - Street 1:1000 S FREMONT AVE UNIT 85
Practice Address - Street 2:
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91803-8822
Practice Address - Country:US
Practice Address - Phone:818-940-4335
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-01
Last Update Date:2024-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6642103K00000X
1-20-46792103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst