Provider Demographics
NPI:1073109054
Name:SMITH, SHAWNEE ISAAC (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SHAWNEE
Middle Name:ISAAC
Last Name:SMITH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:SHAWNEE
Other - Middle Name:
Other - Last Name:ISAAC-SMITH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:1025 INDIANA AVE
Mailing Address - Street 2:
Mailing Address - City:VENICE
Mailing Address - State:CA
Mailing Address - Zip Code:90291-2822
Mailing Address - Country:US
Mailing Address - Phone:310-570-5856
Mailing Address - Fax:
Practice Address - Street 1:1025 INDIANA AVE
Practice Address - Street 2:
Practice Address - City:VENICE
Practice Address - State:CA
Practice Address - Zip Code:90291-2822
Practice Address - Country:US
Practice Address - Phone:310-570-5856
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-14
Last Update Date:2020-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA972671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical