MEDICARE: SHELLEY CHERNOFF KRAMER, PH.D., INC., CLINICAL PSYCHOLOGY

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
1	103TC0700X	Clinical Psychologist	PSY4219	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CP4219A	OTHER	CA	MEDICARE PTAN

General Provider Information

NPI Number	:	1174643035
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHELLEY CHERNOFF KRAMER, PH.D., INC., CLINICAL PSYCHOLOGY

Provider Business Mailing Address
First Line	:	2181 S EL CAMINO REAL
Second Line	:	SUITE 305
City	:	OCEANSIDE
State	:	CA
Zip	:	92054-6220
Country	:	US
Telephone Number	:	760-966-1286
Fax Number	:	760-966-1911

Provider Business Practice Location Address
First Line	:	2181 S EL CAMINO REAL
Second Line	:	STE 305
City	:	OCEANSIDE
State	:	CA
Zip	:	92054-6288
Country	:	US
Telephone Number	:	760-966-1286
Fax Number	:	760-966-1911

Authorized Official
Title or Position	:	PSYCHOLOGIST
Name	:	DR. SHELLEY KRAMER
Credential	:	PHD
Telephone Number	:	760-966-1286

Provider Enumeration Date	:	04/01/2007
Last Update Date	:	07/13/2012

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