Provider Demographics
NPI:1689270324
Name:REID, SHARYL LYNNE (LCSW)
Entity Type:Individual
Prefix:
First Name:SHARYL
Middle Name:LYNNE
Last Name:REID
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 1:30495 CANWOOD ST STE 101
Mailing Address - Street 2:
Mailing Address - City:AGOURA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91301-4331
Mailing Address - Country:US
Mailing Address - Phone:818-707-7366
Mailing Address - Fax:818-306-5836
Practice Address - Street 1:30495 CANWOOD ST STE 101
Practice Address - Street 2:
Practice Address - City:AGOURA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91301-4331
Practice Address - Country:US
Practice Address - Phone:818-707-7366
Practice Address - Fax:818-306-5836
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-08
Last Update Date:2020-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA167101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical