Provider Demographics
NPI:1982723110
Name:SHAW, HEIDI NICOLE (LCSW)
Entity type:Individual
Prefix:MS
First Name:HEIDI
Middle Name:NICOLE
Last Name:SHAW
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12101 W WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90066-5501
Mailing Address - Country:US
Mailing Address - Phone:310-751-1127
Mailing Address - Fax:
Practice Address - Street 1:9440 SANTA MONICA BLVD STE 301
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90210-4614
Practice Address - Country:US
Practice Address - Phone:323-931-6025
Practice Address - Fax:323-931-6027
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAASW11434104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker