Provider Demographics
NPI:1831299304
Name:BISHOP, SHARON LOUISE (PHD)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:LOUISE
Last Name:BISHOP
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 NO ROBERTSON BLVD.
Mailing Address - Street 2:SUITE 807
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-3110
Mailing Address - Country:US
Mailing Address - Phone:310-652-1824
Mailing Address - Fax:310-451-2966
Practice Address - Street 1:116 NO ROBERTSON BLVD.
Practice Address - Street 2:SUITE 807
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-3110
Practice Address - Country:US
Practice Address - Phone:310-652-1824
Practice Address - Fax:310-451-2966
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 11126103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical