Provider Demographics
NPI:1225611551
Name:ODOM, SHARON ROSEMARIECRUZ (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:ROSEMARIECRUZ
Last Name:ODOM
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:SHARON
Other - Middle Name:ROSEMARIE
Other - Last Name:CRUZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:3077 AUTUMNWOOD CT
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95148-2703
Mailing Address - Country:US
Mailing Address - Phone:408-600-4311
Mailing Address - Fax:
Practice Address - Street 1:2101 ALEXIAN DR STE 101
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95116-1901
Practice Address - Country:US
Practice Address - Phone:408-595-9502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-04
Last Update Date:2021-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW969361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical