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General NPI Number Information
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NPI Number | 1235408972
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Entity Type | Individual
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Provider Name | SHANT ARI BARMAK PSY.D.
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Gender | Male
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Dates
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Enumeration Date | 12/27/2011
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Last Update Date | 06/22/2012
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Provider Practice Location Address
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Address Line | 3790 VIA DE LA VALLE STE 104E
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City | DEL MAR
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State | CA
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Zip | 92014-4248
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Country | US
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Telephone | 858-220-8526
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Fax |
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Provider Business Mailing Address
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Address Line | 3790 VIA DE LA VALLE STE 104E
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City | DEL MAR
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State | CA
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Zip | 92014-4248
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Country | US
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Telephone | 858-220-8526
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Fax |
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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 | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | PSY 24998
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License Number State | CA
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