Provider Demographics
NPI:1588786263
Name:WARNER, SHOLEH M (PSYD)
Entity type:Individual
Prefix:MS
First Name:SHOLEH
Middle Name:M
Last Name:WARNER
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1507 7TH ST
Mailing Address - Street 2:
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90401-2605
Mailing Address - Country:US
Mailing Address - Phone:310-625-0802
Mailing Address - Fax:818-719-7278
Practice Address - Street 1:16055 VENTURA BLVD #1010
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2601
Practice Address - Country:US
Practice Address - Phone:310-625-0802
Practice Address - Fax:818-719-7278
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-04
Last Update Date:2017-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA2006119103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASUBB441OtherLA DMH PROVIDER
CA00007570Medicaid