Healthcare Provider Details

I. General information

NPI: 1982249504
Provider Name (Legal Business Name): SHARONA HASSIDIM MSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2019
Last Update Date: 09/11/2020
Certification Date: 09/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6041 CADILLAC AVE
LOS ANGELES CA
90034-1702
US

IV. Provider business mailing address

220 N ALMONT DR APT 2
BEVERLY HILLS CA
90211-1664
US

V. Phone/Fax

Practice location:
  • Phone: 818-815-5944
  • Fax:
Mailing address:
  • Phone: 310-801-0152
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number89848
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: