Healthcare Provider Details

I. General information

NPI: 1174643035
Provider Name (Legal Business Name): SHELLEY CHERNOFF KRAMER, PH.D., INC., CLINICAL PSYCHOLOGY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/01/2007
Last Update Date: 07/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2181 S EL CAMINO REAL STE 305
OCEANSIDE CA
92054-6288
US

IV. Provider business mailing address

2181 S EL CAMINO REAL SUITE 305
OCEANSIDE CA
92054-6220
US

V. Phone/Fax

Practice location:
  • Phone: 760-966-1286
  • Fax: 760-966-1911
Mailing address:
  • Phone: 760-966-1286
  • Fax: 760-966-1911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY4219
License Number StateCA

VIII. Authorized Official

Name: DR. SHELLEY KRAMER
Title or Position: PSYCHOLOGIST
Credential: PHD
Phone: 760-966-1286