Provider Demographics
NPI:1356936157
Name:DELATORRE, SHAWNA ALEXANDRA (AMFT)
Entity type:Individual
Prefix:MS
First Name:SHAWNA
Middle Name:ALEXANDRA
Last Name:DELATORRE
Suffix:
Gender:F
Credentials:AMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36949 FRANKLIN AVE
Mailing Address - Street 2:
Mailing Address - City:MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:93636-8210
Mailing Address - Country:US
Mailing Address - Phone:559-514-2610
Mailing Address - Fax:
Practice Address - Street 1:1470 W HERNDON AVE # 300
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93711-0552
Practice Address - Country:US
Practice Address - Phone:559-256-2000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-03
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT122765106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist