Provider Demographics
NPI:1881945004
Name:SHTAINMAN, LEERON (LCSW)
Entity type:Individual
Prefix:MR
First Name:LEERON
Middle Name:
Last Name:SHTAINMAN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:MR
Other - First Name:RON
Other - Middle Name:
Other - Last Name:SHTAINMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:PO BOX 27891
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92799-7891
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:22055 ARROWHEAD LN
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-2302
Practice Address - Country:US
Practice Address - Phone:949-292-4811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-27
Last Update Date:2023-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS 272451041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical