Basic Information
| Provider Information | |||||||||
| NPI: | 1124334917 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHAHVERDIYEVA | ||||||||
| FirstName: | CAROLINA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | B.A., B.S. | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | MOJICA-LOPEZ | ||||||||
| OtherFirstName: | CAROLINA | ||||||||
| OtherMiddleName: | |||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | CFAAP RS 6514 | ||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 957 INDUSTRIAL RD | ||||||||
| Address2: | SUITE B | ||||||||
| City: | SAN CARLOS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 940704151 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6508326791 | ||||||||
| FaxNumber: | 6506209549 | ||||||||
| Practice Location | |||||||||
| Address1: | 957 INDUSTRIAL RD | ||||||||
| Address2: | SUITE B | ||||||||
| City: | SAN CARLOS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 940704151 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6508326791 | ||||||||
| FaxNumber: | 6506209549 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2010 | ||||||||
| LastUpdateDate: | 08/13/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | N | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 172V00000X | N | Other Service Providers | Community Health Worker | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.