Provider Demographics
NPI:1114496437
Name:SHIRLEY J SUNN, INC LICENSED CLINICAL SOCIAL WORKER
Entity type:Organization
Organization Name:SHIRLEY J SUNN, INC LICENSED CLINICAL SOCIAL WORKER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:SHIRLEY
Authorized Official - Middle Name:JEANNE
Authorized Official - Last Name:SUNN
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:818-835-2698
Mailing Address - Street 1:4305 SALTILLO ST
Mailing Address - Street 2:
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91364-4430
Mailing Address - Country:US
Mailing Address - Phone:818-835-2698
Mailing Address - Fax:
Practice Address - Street 1:20300 VENTURA BLVD STE 315
Practice Address - Street 2:
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364-0903
Practice Address - Country:US
Practice Address - Phone:818-835-2698
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-15
Last Update Date:2018-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty