Provider Demographics
NPI:1659757672
Name:VAUGHN, SHARON (LCSW)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:VAUGHN
Suffix:
Gender:F
Credentials:LCSW
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 1113
Mailing Address - Street 2:
Mailing Address - City:LOMITA
Mailing Address - State:CA
Mailing Address - Zip Code:90717-5113
Mailing Address - Country:US
Mailing Address - Phone:562-295-5916
Mailing Address - Fax:562-295-5958
Practice Address - Street 1:12021 WILMINGTON AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90059-3019
Practice Address - Country:US
Practice Address - Phone:562-295-5916
Practice Address - Fax:562-295-5958
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-31
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS217641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1538130893Medicaid