Healthcare Provider Details

I. General information

NPI: 1174167373
Provider Name (Legal Business Name): SHAWN SINCLAIR LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2019
Last Update Date: 10/30/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15405 LANSDOWNE RD
TUSTIN CA
92782-0200
US

IV. Provider business mailing address

15405 LANSDOWNE RD
TUSTIN CA
92782-0200
US

V. Phone/Fax

Practice location:
  • Phone: 714-258-7710
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number91355
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: