Provider Demographics
NPI:1326247032
Name:CHENEY, SHIRLEY (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SHIRLEY
Middle Name:
Last Name:CHENEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3429 MORNINGSIDE DR
Mailing Address - Street 2:
Mailing Address - City:EL SOBRANTE
Mailing Address - State:CA
Mailing Address - Zip Code:94803-2518
Mailing Address - Country:US
Mailing Address - Phone:510-685-7061
Mailing Address - Fax:510-942-4776
Practice Address - Street 1:13585 SAN PABLO AVENUE, 2ND FLOOR
Practice Address - Street 2:
Practice Address - City:SAN PABLO
Practice Address - State:CA
Practice Address - Zip Code:94806
Practice Address - Country:US
Practice Address - Phone:510-942-4700
Practice Address - Fax:510-942-4776
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-12
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA933231041C0700X
101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)