Healthcare Provider Details

I. General information

NPI: 1962620328
Provider Name (Legal Business Name): MARY R SHAPIRO PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 10/23/2024
Certification Date: 10/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNM HOSPITAL 2211 LOMAS BLVD NE
ALBUQUERQUE NM
87106
US

IV. Provider business mailing address

303 DON FERNANDO RD
SANTA FE NM
87505-1628
US

V. Phone/Fax

Practice location:
  • Phone: 505-272-4763
  • Fax: 505-272-0690
Mailing address:
  • Phone: 505-983-4019
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY1012
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number StateNM
# 3
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License NumberPSY1012
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: