Provider Demographics
NPI:1699339341
Name:KANE, SHARON (LMFT)
Entity type:Individual
Prefix:MS
First Name:SHARON
Middle Name:
Last Name:KANE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10833 WASHINGTON BLVD STE 6
Mailing Address - Street 2:
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90232-3618
Mailing Address - Country:US
Mailing Address - Phone:310-963-6736
Mailing Address - Fax:
Practice Address - Street 1:10833 WASHINGTON BLVD # 6
Practice Address - Street 2:
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90232-3618
Practice Address - Country:US
Practice Address - Phone:310-963-6736
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-29
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC51215103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist