Provider Demographics
NPI:1811743628
Name:SHAGALOV, MARSHA (LCSW)
Entity type:Individual
Prefix:
First Name:MARSHA
Middle Name:
Last Name:SHAGALOV
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 1:20010 HEMMINGWAY ST
Mailing Address - Street 2:
Mailing Address - City:WINNETKA
Mailing Address - State:CA
Mailing Address - Zip Code:91306-2344
Mailing Address - Country:US
Mailing Address - Phone:818-458-9738
Mailing Address - Fax:
Practice Address - Street 1:20010 HEMMINGWAY ST
Practice Address - Street 2:
Practice Address - City:WINNETKA
Practice Address - State:CA
Practice Address - Zip Code:91306-2344
Practice Address - Country:US
Practice Address - Phone:818-458-9738
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-24
Last Update Date:2024-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCSW1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical