Provider Demographics
NPI:1568533560
Name:SHIRMAN, ELLEN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:
Last Name:SHIRMAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17525 VENTURA BLVD
Mailing Address - Street 2:STE 307
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-5159
Mailing Address - Country:US
Mailing Address - Phone:818-995-4477
Mailing Address - Fax:818-995-4171
Practice Address - Street 1:17525 VENTURA BLVD
Practice Address - Street 2:STE 307
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-5159
Practice Address - Country:US
Practice Address - Phone:818-995-4477
Practice Address - Fax:818-995-4171
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY13806103G00000X, 103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY138060Medicaid
CAPSY138060Medicaid
CACP13806Medicare PIN