Provider Demographics
NPI:1336790690
Name:SHERZADA, ANGELITA M (LCSW)
Entity Type:Individual
Prefix:
First Name:ANGELITA
Middle Name:M
Last Name:SHERZADA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ANGELA
Other - Middle Name:M
Other - Last Name:SHERZADA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:1534 WELLS AVE
Mailing Address - Street 2:
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711-3341
Mailing Address - Country:US
Mailing Address - Phone:626-622-0638
Mailing Address - Fax:
Practice Address - Street 1:250 W. FIRST STREET
Practice Address - Street 2:242
Practice Address - City:CLAREMONT
Practice Address - State:CA
Practice Address - Zip Code:91711
Practice Address - Country:US
Practice Address - Phone:626-622-0638
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-26
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA828491041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical