Provider Demographics
NPI:1619185881
Name:SHAW, SHARON KAY (LMFT)
Entity Type:Individual
Prefix:MS
First Name:SHARON
Middle Name:KAY
Last Name:SHAW
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MS
Other - First Name:SHARON
Other - Middle Name:KAY
Other - Last Name:ROSS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:4523 WOODMAN AVE
Mailing Address - Street 2:#108
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91423-3060
Mailing Address - Country:US
Mailing Address - Phone:818-907-7229
Mailing Address - Fax:
Practice Address - Street 1:329 N WETHERLY DR
Practice Address - Street 2:204
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-1605
Practice Address - Country:US
Practice Address - Phone:310-274-5747
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA25158106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist