Provider Demographics
NPI:1124269121
Name:SHORTINO, LYNN CAROL (MS, MFT)
Entity type:Individual
Prefix:MS
First Name:LYNN
Middle Name:CAROL
Last Name:SHORTINO
Suffix:
Gender:F
Credentials:MS, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6520 PLATT AVE # 352
Mailing Address - Street 2:
Mailing Address - City:WEST HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91307-3218
Mailing Address - Country:US
Mailing Address - Phone:818-424-5014
Mailing Address - Fax:818-884-4564
Practice Address - Street 1:22301 MULHOLLAND HWY
Practice Address - Street 2:200
Practice Address - City:CALABASAS
Practice Address - State:CA
Practice Address - Zip Code:91302-5140
Practice Address - Country:US
Practice Address - Phone:818-424-5014
Practice Address - Fax:818-884-4564
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-20
Last Update Date:2010-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA32580106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist