| Golden State Licensed Clinical Social Worker Inc. | |
|
3252 Holiday Ct Ste 102 La Jolla CA 92037-1807 | |
| (714) 222-7786 | |
| Not Available |
| Full Name | Golden State Licensed Clinical Social Worker Inc. |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 3252 Holiday Ct Ste 102, La Jolla, California |
| Authorized Official Name and Position | Roxanna Shafizadeh (LICENSED CLINICAL SOCIAL WORKER) |
| Authorized Official Contact | 7142227786 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Golden State Licensed Clinical Social Worker Inc. 3252 Holiday Ct Ste 102 La Jolla CA 92037-1807 Ph: (714) 222-7786 | Golden State Licensed Clinical Social Worker Inc. 3252 Holiday Ct Ste 102 La Jolla CA 92037-1807 Ph: (714) 222-7786 |
| NPI Number | 1457165599 |
|---|---|
| Provider Enumeration Date | 02/06/2025 |
| Last Update Date | 02/06/2025 |
| Certification Date | 02/06/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1457165599 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
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