Healthcare Provider Details

I. General information

NPI: 1245400340
Provider Name (Legal Business Name): MIRIAM ELISE SHENFELD PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/04/2008
Last Update Date: 03/04/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

260 S LOS ROBLES AVE STE 102
PASADENA CA
91101-2824
US

IV. Provider business mailing address

5014 COMMONWEALTH AVE
LA CANADA CA
91011-2402
US

V. Phone/Fax

Practice location:
  • Phone: 818-952-9400
  • Fax:
Mailing address:
  • Phone: 818-952-9400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberPSY9921
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY9921
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY9921
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: