MEDICARE: MS. SHRUTI SHANKAR MAP, MA AMFT

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	103TP2701X	Group Psychotherapy Psychologist

General Provider Information

NPI Number	:	1356048219
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SHRUTI SHANKAR MAP, MA AMFT

Provider Business Mailing Address
First Line	:	828 6TH ST APT 8
Second Line	:
City	:	SANTA MONICA
State	:	CA
Zip	:	90403-1415
Country	:	US
Telephone Number	:	424-341-5193
Fax Number	:

Provider Business Practice Location Address
First Line	:	934 HERMOSA AVE STE 11
Second Line	:
City	:	HERMOSA BEACH
State	:	CA
Zip	:	90254-4122
Country	:	US
Telephone Number	:	310-957-2122
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/10/2023
Last Update Date	:	02/10/2023

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