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General NPI Number Information
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NPI Number | 1447540299
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Entity Type | Individual
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Provider Name | BONNY SHAPIN PH.D.
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Gender | Female
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Dates
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Enumeration Date | 04/13/2011
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Last Update Date | 10/15/2012
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Provider Practice Location Address
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Address Line | 415 W FOOTHILL BLVD STE 212
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City | CLAREMONT
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State | CA
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Zip | 91711-2780
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Country | US
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Telephone | 909-921-3828
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Fax | 888-433-3022
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Provider Business Mailing Address
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Address Line | 175 S COLLEGE AVE
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City | CLAREMONT
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State | CA
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Zip | 91711-5003
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Country | US
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Telephone | 909-921-3828
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Fax | 909-624-6796
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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 | 18643
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License Number State | CA
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