Provider Demographics
NPI:1043426968
Name:CROSBY, SHARON (MFT)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:CROSBY
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:SHARON
Other - Middle Name:
Other - Last Name:WASSERMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:14150 CULVER DR STE 307
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-0323
Mailing Address - Country:US
Mailing Address - Phone:949-857-0760
Mailing Address - Fax:
Practice Address - Street 1:14150 CULVER DR STE 307
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-0323
Practice Address - Country:US
Practice Address - Phone:949-857-0760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT 18271106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist