Provider Demographics
NPI:1174892806
Name:SARIG NADAV, SHELLY (LMFT)
Entity type:Individual
Prefix:
First Name:SHELLY
Middle Name:
Last Name:SARIG NADAV
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:SHELLY
Other - Middle Name:
Other - Last Name:SARIG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:467 HAMILTON AVE. SUITE 25
Mailing Address - Street 2:
Mailing Address - City:PALO ALTO
Mailing Address - State:CA
Mailing Address - Zip Code:94301
Mailing Address - Country:US
Mailing Address - Phone:650-283-4488
Mailing Address - Fax:408-294-2451
Practice Address - Street 1:467 HAMILTON AVE. SUITE 25
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94301
Practice Address - Country:US
Practice Address - Phone:650-283-4488
Practice Address - Fax:408-294-2451
Is Sole Proprietor?:No
Enumeration Date:2011-12-27
Last Update Date:2019-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA112269101Y00000X, 106H00000X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor