MEDICARE: DR. STACEY J SHUSTER PHD

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	PSY12162	CA

General Provider Information

NPI Number	:	1962562587
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STACEY J SHUSTER PHD

Provider Business Mailing Address
First Line	:	45 FRANKLIN STREET
Second Line	:	SUITE 320
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94102-6047
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	45 FRANKLIN STREET
Second Line	:	SUITE 320
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94102-6047
Country	:	US
Telephone Number	:	415-285-8755
Fax Number	:	415-626-0234

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

Provider Enumeration Date	:	12/12/2006
Last Update Date	:	07/08/2007

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