Provider Demographics
NPI:1306130174
Name:SHOHAM, CAROLIN (PHD)
Entity type:Individual
Prefix:DR
First Name:CAROLIN
Middle Name:
Last Name:SHOHAM
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 1:9454 WILSHIRE BLVD PH 24
Mailing Address - Street 2:
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-2937
Mailing Address - Country:US
Mailing Address - Phone:310-248-2662
Mailing Address - Fax:
Practice Address - Street 1:9454 WILSHIRE BLVD PH 24
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-2937
Practice Address - Country:US
Practice Address - Phone:310-248-2662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-08
Last Update Date:2019-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY20371103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFE352AOtherP10