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General NPI Number Information
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NPI Number | 1104997568
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Entity Type | Individual
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Provider Name | BEVERLY L. SHAW PH. D.
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Gender | Female
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Dates
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Enumeration Date | 11/10/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1722 WESTWOOD BLVD STE 103
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City | LOS ANGELES
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State | CA
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Zip | 90024-5637
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Country | US
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Telephone | 310-470-2247
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Fax | 310-470-4606
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Provider Business Mailing Address
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Address Line | 1768 GLENDON AVE #1
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City | LOS ANGELES
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State | CA
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Zip | 90024-5740
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Country | US
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Telephone | 310-470-9422
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Fax | 310-470-4606
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | MFC209661
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License Number State | CA
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