Healthcare Provider Details

I. General information

NPI: 1164044541
Provider Name (Legal Business Name): TARYN SHAPPELL LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2020
Last Update Date: 05/08/2020
Certification Date: 05/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1825 4TH ST
SAN FRANCISCO CA
94143-2350
US

IV. Provider business mailing address

510 OAK ST
SAN FRANCISCO CA
94102-5523
US

V. Phone/Fax

Practice location:
  • Phone: 415-502-4116
  • Fax:
Mailing address:
  • Phone: 415-640-8116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number29384
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: