Provider Demographics
NPI:1356496657
Name:HANSEN, SHIRLEY MAE (LCSW)
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:MAE
Last Name:HANSEN
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 1:4482 MARKET ST
Mailing Address - Street 2:SUITE 405
Mailing Address - City:VENTURA
Mailing Address - State:CA
Mailing Address - Zip Code:93003-8022
Mailing Address - Country:US
Mailing Address - Phone:805-339-0930
Mailing Address - Fax:805-339-0930
Practice Address - Street 1:4482 MARKET ST
Practice Address - Street 2:SUITE 405
Practice Address - City:VENTURA
Practice Address - State:CA
Practice Address - Zip Code:93003-8022
Practice Address - Country:US
Practice Address - Phone:805-339-0930
Practice Address - Fax:805-339-0930
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS37411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical