MEDICARE: DR. C SHOHAM PSYCHOLOGICAL SERVICES

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	PSY20371	CA

General Provider Information

NPI Number	:	1366931339
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. C SHOHAM PSYCHOLOGICAL SERVICES

Provider Business Mailing Address
First Line	:	9454 WILSHIRE BLVD STE 24
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90212-2931
Country	:	US
Telephone Number	:	310-248-2662
Fax Number	:

Provider Business Practice Location Address
First Line	:	9454 WILSHIRE BLVD STE 24
Second Line	:
City	:	BEVERLY HILLS
State	:	CA
Zip	:	90212-2931
Country	:	US
Telephone Number	:	310-248-2662
Fax Number	:

Authorized Official
Title or Position	:	PH.D.
Name	:	CAROLIN SHOHAM
Credential	:	PH.D.
Telephone Number	:	310-248-2662

Provider Enumeration Date	:	05/05/2018
Last Update Date	:	05/05/2018

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