MEDICARE: VARIATIONS PSYCHOLOGY PC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	103G00000X	Clinical Neuropsychologist
2	103TC2200X	Clinical Child & Adolescent Psychologist
3	103TF0200X	Forensic Psychologist
4	103TM1800X	Intellectual & Developmental Disabilities Psychologist
5	103TC0700X	Clinical Psychologist

General Provider Information

NPI Number	:	1447182472
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VARIATIONS PSYCHOLOGY PC

Provider Business Mailing Address
First Line	:	1048 IRVINE AVE # 717
Second Line	:
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-4602
Country	:	US
Telephone Number	:	949-873-4617
Fax Number	:	949-209-4544

Provider Business Practice Location Address
First Line	:	3525 HYLAND AVE STE 205
Second Line	:
City	:	COSTA MESA
State	:	CA
Zip	:	92626-1403
Country	:	US
Telephone Number	:	949-873-4617
Fax Number	:	949-209-4544

Authorized Official
Title or Position	:	CEO, LICENSED PSYCHOLOGIST
Name	:	DR. MARTA M. SHINN
Credential	:	PHD
Telephone Number	:	949-424-5707

Provider Enumeration Date	:	06/02/2026
Last Update Date	:	06/02/2026

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