Provider Demographics
NPI:1336345289
Name:HART, SHIRIN (LMFT)
Entity Type:Individual
Prefix:
First Name:SHIRIN
Middle Name:
Last Name:HART
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 25072
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90025-0072
Mailing Address - Country:US
Mailing Address - Phone:310-400-2714
Mailing Address - Fax:
Practice Address - Street 1:4325 W SUNSET BLVD
Practice Address - Street 2:#206
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90029-2174
Practice Address - Country:US
Practice Address - Phone:310-402-9000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-26
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53668106H00000X
CA77530106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist