Healthcare Provider Details

I. General information

NPI: 1851933949
Provider Name (Legal Business Name): SHERIDAN NOLAN GODFREY ONEAL LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/10/2019
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1274 N CRESCENT HEIGHTS BLVD APT 125
WEST HOLLYWOOD CA
90046-5059
US

IV. Provider business mailing address

1274 N CRESCENT HEIGHTS BLVD APT 125
WEST HOLLYWOOD CA
90046-5059
US

V. Phone/Fax

Practice location:
  • Phone: 310-346-4405
  • Fax:
Mailing address:
  • Phone: 310-346-4405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number138321
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: