Provider Demographics
NPI:1033272463
Name:SHATKIN, PAULA D (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:PAULA
Middle Name:D
Last Name:SHATKIN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1360 N DUTTON AVE STE C
Mailing Address - Street 2:
Mailing Address - City:SANTA ROSA
Mailing Address - State:CA
Mailing Address - Zip Code:95401-4668
Mailing Address - Country:US
Mailing Address - Phone:707-303-1531
Mailing Address - Fax:707-571-8195
Practice Address - Street 1:1360 N DUTTON AVE STE C
Practice Address - Street 2:
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95401-4668
Practice Address - Country:US
Practice Address - Phone:707-303-1531
Practice Address - Fax:707-571-8195
Is Sole Proprietor?:No
Enumeration Date:2006-12-18
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS157971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ22370ZMedicare PIN