Provider Demographics
NPI:1487200044
Name:SHULMAN, DEE DEE
Entity Type:Individual
Prefix:
First Name:DEE DEE
Middle Name:
Last Name:SHULMAN
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:PO BOX 2702
Mailing Address - Street 2:
Mailing Address - City:TOLUCA LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:91610-0702
Mailing Address - Country:US
Mailing Address - Phone:818-665-5656
Mailing Address - Fax:
Practice Address - Street 1:10945 HORTENSE ST APT 303
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91602-1752
Practice Address - Country:US
Practice Address - Phone:818-665-5656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-08-09
Last Update Date:2019-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS114421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical