Provider Demographics
NPI:1487740346
Name:BOOTH, SHARON MARIE (MSW LCSW)
Entity type:Individual
Prefix:MS
First Name:SHARON
Middle Name:MARIE
Last Name:BOOTH
Suffix:
Gender:F
Credentials:MSW LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4120 CAMERON PARK DR
Mailing Address - Street 2:STE 403
Mailing Address - City:CAMERON PARK
Mailing Address - State:CA
Mailing Address - Zip Code:95682
Mailing Address - Country:US
Mailing Address - Phone:530-677-5764
Mailing Address - Fax:530-676-1782
Practice Address - Street 1:4120 CAMERON PARK DR
Practice Address - Street 2:STE 403
Practice Address - City:CAMERON PARK
Practice Address - State:CA
Practice Address - Zip Code:95682
Practice Address - Country:US
Practice Address - Phone:530-677-5764
Practice Address - Fax:530-676-1782
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALCS57291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ26296ZOtherBLUE SHIELD
6250764OtherUBH
0000033137051117OtherMHN
069574OtherVO
0004318938OtherAETNA
6250764OtherUBH
ZZZ26296ZMedicare UPIN