MEDICARE: MIRIAM SHAPIRO PHD

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	PSY004028	GA

General Provider Information

NPI Number	:	1861877292
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MIRIAM SHAPIRO PHD

Provider Business Mailing Address
First Line	:	1608 ADELIA PL NE
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30329-3808
Country	:	US
Telephone Number	:	314-440-6175
Fax Number	:	770-933-4135

Provider Business Practice Location Address
First Line	:	2400 LAKE PARK DR SE STE 110
Second Line	:
City	:	SMYRNA
State	:	GA
Zip	:	30080-8979
Country	:	US
Telephone Number	:	770-933-4130
Fax Number	:	770-933-4135

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

Provider Enumeration Date	:	07/27/2015
Last Update Date	:	06/27/2023

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Directions to “ MIRIAM SHAPIRO PHD” Practice Location

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