Provider Demographics
NPI:1902836224
Name:SHIRLEY, NADINE ANN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:NADINE
Middle Name:ANN
Last Name:SHIRLEY
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 1:7777 SOUTH FREEDOM RD
Mailing Address - Street 2:
Mailing Address - City:FRENCH CAMP
Mailing Address - State:CA
Mailing Address - Zip Code:95231-3400
Mailing Address - Country:US
Mailing Address - Phone:209-946-3406
Mailing Address - Fax:209-946-3458
Practice Address - Street 1:7777 S. FREEDOM RD
Practice Address - Street 2:
Practice Address - City:FRENCH CAMP
Practice Address - State:CA
Practice Address - Zip Code:95231-3400
Practice Address - Country:US
Practice Address - Phone:209-946-3406
Practice Address - Fax:209-946-3458
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS217591041C0700X
MT622 LCSW1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical