Provider Demographics
NPI:1417106709
Name:WORSLEY, SHAWAN MONIQUE
Entity Type:Individual
Prefix:MRS
First Name:SHAWAN
Middle Name:MONIQUE
Last Name:WORSLEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 MYRTLE ST
Mailing Address - Street 2:102
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94607-2525
Mailing Address - Country:US
Mailing Address - Phone:510-356-7165
Mailing Address - Fax:510-839-3888
Practice Address - Street 1:111 MYRTLE ST
Practice Address - Street 2:102
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94607-2525
Practice Address - Country:US
Practice Address - Phone:510-839-3800
Practice Address - Fax:510-839-3888
Is Sole Proprietor?:No
Enumeration Date:2008-09-11
Last Update Date:2010-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA63059106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist