Provider Demographics
NPI:1013459874
Name:BOURANG, SHAMERIN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SHAMERIN
Middle Name:
Last Name:BOURANG
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 1:1225 OAKDALE RD
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-3357
Mailing Address - Country:US
Mailing Address - Phone:209-667-9711
Mailing Address - Fax:
Practice Address - Street 1:1225 OAKDALE RD
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-3357
Practice Address - Country:US
Practice Address - Phone:209-557-6213
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-10
Last Update Date:2019-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW743041041C0700X
CA830061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical