Provider Demographics
NPI:1295442796
Name:SHAHGALDIYEVA, JEYRAN (LISW-S)
Entity type:Individual
Prefix:
First Name:JEYRAN
Middle Name:
Last Name:SHAHGALDIYEVA
Suffix:
Gender:F
Credentials:LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 KING JAMES PKWY APT 146
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-3476
Mailing Address - Country:US
Mailing Address - Phone:216-970-1747
Mailing Address - Fax:
Practice Address - Street 1:2000 KING JAMES PKWY APT 146
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-3476
Practice Address - Country:US
Practice Address - Phone:216-970-1747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-03
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI.2002448-SUPV1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical