Provider Demographics
NPI:1679180764
Name:AMADORE, SHAUNA (PSYD, LMFT)
Entity Type:Individual
Prefix:DR
First Name:SHAUNA
Middle Name:
Last Name:AMADORE
Suffix:
Gender:F
Credentials:PSYD, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 DOVE ST STE 260
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-2803
Mailing Address - Country:US
Mailing Address - Phone:949-939-0242
Mailing Address - Fax:
Practice Address - Street 1:1101 DOVE ST STE 260
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-2803
Practice Address - Country:US
Practice Address - Phone:949-939-0242
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-23
Last Update Date:2020-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA102L00000X
CAMFC35135106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst