Provider Demographics
NPI:1861742637
Name:SHARIFI, FARIBA (PSYD)
Entity type:Individual
Prefix:
First Name:FARIBA
Middle Name:
Last Name:SHARIFI
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 571063
Mailing Address - Street 2:
Mailing Address - City:TARZANA
Mailing Address - State:CA
Mailing Address - Zip Code:91357-1063
Mailing Address - Country:US
Mailing Address - Phone:818-620-6646
Mailing Address - Fax:
Practice Address - Street 1:5535 BALBOA BLVD
Practice Address - Street 2:STE 200
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-1534
Practice Address - Country:US
Practice Address - Phone:818-620-6646
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-19
Last Update Date:2017-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 25212103TC0700X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical