Provider Demographics
NPI:1386843035
Name:KAHENZADEH, SHIRLEY MONA (MSW, LCSW)
Entity Type:Individual
Prefix:MS
First Name:SHIRLEY
Middle Name:MONA
Last Name:KAHENZADEH
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5767 W CENTURY BLVD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90045-5631
Mailing Address - Country:US
Mailing Address - Phone:310-285-9300
Mailing Address - Fax:310-285-9300
Practice Address - Street 1:9300 WILSHIRE BLVD
Practice Address - Street 2:SUITE 320
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-3213
Practice Address - Country:US
Practice Address - Phone:310-285-9300
Practice Address - Fax:310-285-9300
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-13
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS234271041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACC859ZMedicare PIN