Provider Demographics
NPI:1013037787
Name:DSA, SHEFALI (MFT)
Entity Type:Individual
Prefix:
First Name:SHEFALI
Middle Name:
Last Name:DSA
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 S DE LACEY AVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-2048
Mailing Address - Country:US
Mailing Address - Phone:626-395-7100
Mailing Address - Fax:626-799-4596
Practice Address - Street 1:210 S DE LACEY AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-2048
Practice Address - Country:US
Practice Address - Phone:626-395-7100
Practice Address - Fax:626-799-4596
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2013-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC47239106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist