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General NPI Number Information
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NPI Number | 1912524828
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Entity Type | Individual
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Provider Name | JENNA B SHAPIRO PHD
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Gender | Female
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Dates
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Enumeration Date | 06/26/2020
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Last Update Date | 03/04/2025
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Provider Practice Location Address
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Address Line | 433 PLAZA REAL STE 275
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City | BOCA RATON
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State | FL
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Zip | 33432-3999
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Country | US
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Telephone | 312-561-6805
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Fax |
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Provider Business Mailing Address
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Address Line | 220 SE MIZNER BLVD UNIT 210
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City | BOCA RATON
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State | FL
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Zip | 33432-5205
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Country | US
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Telephone | 312-561-6805
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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 | 071.010336
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PY12316
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License Number State | FL
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