Healthcare Provider Details

I. General information

NPI: 1629994900
Provider Name (Legal Business Name): SHELBY BRYN LAYNE MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2026
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5535 BALBOA BLVD STE 202
ENCINO CA
91316-1541
US

IV. Provider business mailing address

1037 21ST ST
SANTA MONICA CA
90403-4515
US

V. Phone/Fax

Practice location:
  • Phone: 818-646-7190
  • Fax:
Mailing address:
  • Phone: 818-646-7190
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberASW139640
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: