MEDICARE: DR SUSAN SHAPIRO PSYCHOLOGIST, INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	103TA0400X	Addiction (Substance Use Disorder) Psychologist
2	103TB0200X	Cognitive & Behavioral Psychologist
3	103TC0700X	Clinical Psychologist
4	103TC1900X	Counseling Psychologist
5	103TH0004X	Health Psychologist
6	103T00000X	Psychologist

General Provider Information

NPI Number	:	1326661331
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR SUSAN SHAPIRO PSYCHOLOGIST, INC

Provider Business Mailing Address
First Line	:	269 S BEVERLY DR # 812
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90212-3851
Country	:	US
Telephone Number	:	310-659-7800
Fax Number	:	855-393-9770

Provider Business Practice Location Address
First Line	:	1647 S HAYWORTH AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90035-4513
Country	:	US
Telephone Number	:	310-659-7800
Fax Number	:

Authorized Official
Title or Position	:	PSYCHOLOGIST/OWNER
Name	:	DR. SUSAN SHAPIRO
Credential	:	PHD
Telephone Number	:	310-659-7800

Provider Enumeration Date	:	05/26/2020
Last Update Date	:	05/26/2020

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