Provider Demographics
NPI:1588860423
Name:LOTAN, SHARI ANN
Entity Type:Individual
Prefix:
First Name:SHARI
Middle Name:ANN
Last Name:LOTAN
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 1:145 HODENCAMP RD
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-5810
Mailing Address - Country:US
Mailing Address - Phone:805-449-3510
Mailing Address - Fax:
Practice Address - Street 1:145 HODENCAMP RD
Practice Address - Street 2:
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360-5810
Practice Address - Country:US
Practice Address - Phone:805-449-3501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-26
Last Update Date:2014-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALV125811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical