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NPI Code Detail

MEDICARE: ROMAN M SHAIN

MEDICARE: ROMAN M SHAIN
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106H00000XMarriage & Family TherapistMFC39885CA

General Provider Information

NPI Number : 1134250467
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROMAN M SHAIN
Provider Business Mailing Address
First Line : 5809 RESEDA BLVD
Second Line : #110
City : TARZANA
State : CA
Zip : 91356-2026
Country : US
Telephone Number : 818-609-1804
Fax Number :
Provider Business Practice Location Address
First Line : 6305 WOODMAN AVE
Second Line :
City : VAN NUYS
State : CA
Zip : 91401-2346
Country : US
Telephone Number : 818-909-3380
Fax Number : 818-909-3383
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/08/2007
Last Update Date : 07/08/2007

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Directions to “ ROMAN M SHAIN ” Practice Location

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