Healthcare Provider Details

I. General information

NPI: 1144504523
Provider Name (Legal Business Name): JERALD EDWARD SHAPIRO L.C.S.W. #5905
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/04/2011
Last Update Date: 10/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1881 MEADOW LN
WALNUT CREEK CA
94595-2629
US

IV. Provider business mailing address

1881 MEADOW LN
WALNUT CREEK CA
94595-2629
US

V. Phone/Fax

Practice location:
  • Phone: 925-944-1176
  • Fax:
Mailing address:
  • Phone: 925-944-1176
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberL.C.S.W. 5905
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: