Provider Demographics
NPI:1922417435
Name:SHOHAM, ORNIT (MFT)
Entity Type:Individual
Prefix:
First Name:ORNIT
Middle Name:
Last Name:SHOHAM
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 PAUL SCANNELL DR
Mailing Address - Street 2:
Mailing Address - City:SAN MATEO
Mailing Address - State:CA
Mailing Address - Zip Code:94402-4061
Mailing Address - Country:US
Mailing Address - Phone:650-395-7121
Mailing Address - Fax:
Practice Address - Street 1:222 PAUL SCANNELL DR
Practice Address - Street 2:
Practice Address - City:SAN MATEO
Practice Address - State:CA
Practice Address - Zip Code:94402-4061
Practice Address - Country:US
Practice Address - Phone:650-312-5395
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-08
Last Update Date:2021-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA94719106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist