Healthcare Provider Details

I. General information

NPI: 1407936073
Provider Name (Legal Business Name): SHEREE LYNN EARLE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2006
Last Update Date: 10/02/2025
Certification Date: 10/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8780 19TH ST # 344
ALTA LOMA CA
91701-4608
US

IV. Provider business mailing address

8780 19TH ST # 344
ALTA LOMA CA
91701-4608
US

V. Phone/Fax

Practice location:
  • Phone: 909-256-7986
  • Fax:
Mailing address:
  • Phone: 909-256-7986
  • Fax: 909-256-7983

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLCS15695
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: