Provider Demographics
NPI:1104950286
Name:SHARON, DEBRA MELINDA (PHD)
Entity type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:MELINDA
Last Name:SHARON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6455 COLDWATER CANYON AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91606-1112
Mailing Address - Country:US
Mailing Address - Phone:818-623-6340
Mailing Address - Fax:818-623-6390
Practice Address - Street 1:6455 COLDWATER CANYON AVE
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91606-1112
Practice Address - Country:US
Practice Address - Phone:818-623-6340
Practice Address - Fax:818-623-6390
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 8908103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSIX 324OtherDMH STAFF NUMBER