Provider Demographics
NPI:1265471346
Name:DORONN, SHANA (LCSW, PSYD)
Entity Type:Individual
Prefix:DR
First Name:SHANA
Middle Name:
Last Name:DORONN
Suffix:
Gender:F
Credentials:LCSW, PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1923 1/2 WESTWOOD BLVD
Mailing Address - Street 2:SUITE 2
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-8413
Mailing Address - Country:US
Mailing Address - Phone:310-903-7115
Mailing Address - Fax:
Practice Address - Street 1:1923 1/2 WESTWOOD BLVD
Practice Address - Street 2:SUITE 2
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90025-8413
Practice Address - Country:US
Practice Address - Phone:310-903-7115
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS183671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASW18367OtherPIN