=====================================================
General NPI Number Information
=====================================================
NPI Number | 1659540334
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | S. ABBY SHAPIRO, PH. D., PSC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/26/2008
-----------------------------------------------------
Last Update Date | 02/26/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 120 SEARS AVE
-----------------------------------------------------
City | LOUISVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40207-5072
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 502-893-5332
-----------------------------------------------------
Fax | 592-893-5764
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 120 SEARS AVE SUITE 204
-----------------------------------------------------
City | LOUISVILLE
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40207-5072
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 502-894-5332
-----------------------------------------------------
Fax | 502-893-5764
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. S. ABBY SHAPIRO
-----------------------------------------------------
Credential | PH. D.
-----------------------------------------------------
Telephone | 502-893-5332
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number | 526
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------