Basic Information
| Provider Information | |||||||||
| NPI: | 1487735825 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHAH | ||||||||
| FirstName: | SANJAY | ||||||||
| MiddleName: | V. | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LCSW | ||||||||
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| Mailing Information | |||||||||
| Address1: | 550 S VERMONT AVE FL 10 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900201912 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6262583022 | ||||||||
| FaxNumber: | 5628683749 | ||||||||
| Practice Location | |||||||||
| Address1: | 550 S VERMONT AVE FL 10 | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900201912 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6262583022 | ||||||||
| FaxNumber: | 5628683749 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/18/2006 | ||||||||
| LastUpdateDate: | 03/30/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 03/30/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 17375 | CA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.