MEDICARE: MS. SHIRLEY MONA KAHENZADEH M.S.W., L.C.S.W.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	LCS23427	CA

General Provider Information

NPI Number	:	1386843035
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SHIRLEY MONA KAHENZADEH M.S.W., L.C.S.W.

Provider Business Mailing Address
First Line	:	5767 W CENTURY BLVD
Second Line	:	SUITE 400
City	:	LOS ANGELES
State	:	CA
Zip	:	90045-5631
Country	:	US
Telephone Number	:	310-285-9300
Fax Number	:	310-285-9300

Provider Business Practice Location Address
First Line	:	9300 WILSHIRE BLVD
Second Line	:	SUITE 320
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90212-3213
Country	:	US
Telephone Number	:	310-285-9300
Fax Number	:	310-285-9300

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/13/2007
Last Update Date	:	10/03/2013

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