Healthcare Provider Details

I. General information

NPI: 1033058839
Provider Name (Legal Business Name): SHAW PSYCHOLOGICAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2026
Last Update Date: 03/26/2026
Certification Date: 03/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2635 CAMINO DEL RIO S STE 104
SAN DIEGO CA
92108-3727
US

IV. Provider business mailing address

2635 CAMINO DEL RIO S STE 104
SAN DIEGO CA
92108-3727
US

V. Phone/Fax

Practice location:
  • Phone: 858-848-6722
  • Fax:
Mailing address:
  • Phone: 858-848-6722
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State

VIII. Authorized Official

Name: MORGAN SHAW
Title or Position: OWNER
Credential: PSYD
Phone: 818-800-9076