MEDICARE: DR. SUSAN SHAPIRO PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	007687	NY
2	103TC2200X	Clinical Child & Adolescent Psychologist	007697	NY
3	103TF0000X	Family Psychologist	007687	NY
4	103TM1800X	Intellectual & Developmental Disabilities Psychologist	007687	NY
5	103TS0200X	School Psychologist	007687	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	007687	OTHER	NY	NEW YORK STATE EDUCATION DEPARTMENT

General Provider Information

NPI Number	:	1225273725
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUSAN SHAPIRO PH.D.

Provider Business Mailing Address
First Line	:	1668 MOGUL DR
Second Line	:
City	:	MOHEGAN LAKE
State	:	NY
Zip	:	10547-1848
Country	:	US
Telephone Number	:	914-263-4978
Fax Number	:	914-528-7818

Provider Business Practice Location Address
First Line	:	1668 MOGUL DR
Second Line	:
City	:	MOHEGAN LAKE
State	:	NY
Zip	:	10547-1848
Country	:	US
Telephone Number	:	914-263-4978
Fax Number	:	914-528-7818

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/11/2008
Last Update Date	:	12/11/2008

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