Provider Demographics
NPI:1083795454
Name:SUNN, SHIRLEY JEANNE (LCSW, DSW)
Entity Type:Individual
Prefix:MS
First Name:SHIRLEY
Middle Name:JEANNE
Last Name:SUNN
Suffix:
Gender:F
Credentials:LCSW, DSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4305 SALTILLO STREET
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-4430
Mailing Address - Country:US
Mailing Address - Phone:818-710-8852
Mailing Address - Fax:
Practice Address - Street 1:20300 VENTURA BLVD. SUITE 330
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-1173
Practice Address - Country:US
Practice Address - Phone:818-710-8852
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-18
Last Update Date:2019-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS171551041C0700X
LCS171551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty