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General NPI Number Information
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NPI Number | 1356048219
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Entity Type | Individual
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Provider Name | SHRUTI SHANKAR MAP, MA AMFT
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Gender | Female
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Dates
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Enumeration Date | 02/10/2023
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Last Update Date | 02/10/2023
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Provider Practice Location Address
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Address Line | 934 HERMOSA AVE STE 11
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City | HERMOSA BEACH
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State | CA
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Zip | 90254-4122
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Country | US
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Telephone | 310-957-2122
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Fax |
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Provider Business Mailing Address
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Address Line | 828 6TH ST APT 8
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City | SANTA MONICA
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State | CA
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Zip | 90403-1415
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Country | US
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Telephone | 424-341-5193
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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 | 103TP2701X
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Taxonomy Name | Group Psychotherapy Psychologist
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License Number |
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License Number State |
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