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General NPI Number Information
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NPI Number | 1134393580
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Entity Type | Organization
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Legal Business Name | JAY SHAPIRO, PH.D., P.S.
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Dates
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Enumeration Date | 04/16/2008
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Last Update Date | 04/16/2008
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Provider Practice Location Address
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Address Line | 2200 112TH AVE NE SUITE 100
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City | BELLEVUE
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State | WA
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Zip | 98004-2951
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Country | US
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Telephone | 425-453-7499
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Fax |
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Provider Business Mailing Address
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Address Line | 2200 112TH AVE NE SUITE 100
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City | BELLEVUE
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State | WA
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Zip | 98004-2951
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JAY WAYNE SHAPIRO
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Credential | PH.D.
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Telephone | 425-453-7499
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 000414
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License Number State | WA
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