Basic Information
| Provider Information | |||||||||
| NPI: | 1609007483 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHAPIRO | ||||||||
| FirstName: | SCOTT | ||||||||
| MiddleName: | MICHAEL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1145 GAYLEY AVENUE | ||||||||
| Address2: | 322 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 90024 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3102087187 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1145 GAYLEY AVE | ||||||||
| Address2: | 322 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900243423 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3102087187 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/28/2009 | ||||||||
| LastUpdateDate: | 07/09/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC0700X | 25301 | CA | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.