Provider Demographics
NPI:1891953147
Name:CLIFTON, SHANNON K (MSW)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:K
Last Name:CLIFTON
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12440 E FIRESTONE BLVD
Mailing Address - Street 2:SUITE 1000
Mailing Address - City:NORWALK
Mailing Address - State:CA
Mailing Address - Zip Code:90650
Mailing Address - Country:US
Mailing Address - Phone:562-864-3722
Mailing Address - Fax:562-864-4596
Practice Address - Street 1:12440 FIRESTONE BLVD
Practice Address - Street 2:SUITE 1000
Practice Address - City:NORWALK
Practice Address - State:CA
Practice Address - Zip Code:90650-4328
Practice Address - Country:US
Practice Address - Phone:562-864-3722
Practice Address - Fax:562-894-4596
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-22
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW22221101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health