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General NPI Number Information
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NPI Number | 1407276082
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Entity Type | Individual
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Provider Name | BENJAMIN G SHAPERO PH.D.
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Gender | Male
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Dates
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Enumeration Date | 04/22/2014
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Last Update Date | 02/06/2019
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Provider Practice Location Address
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Address Line | 7825 TUCKERMAN LN STE 209
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City | POTOMAC
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State | MD
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Zip | 20854
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Country | US
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Telephone | 301-338-8784
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Fax |
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Provider Business Mailing Address
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Address Line | 6417 ROCK FOREST DR APT 109
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City | BETHESDA
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State | MD
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Zip | 20817-7860
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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 |
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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 | 06019
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License Number State | MD
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