MEDICARE: DR. JENNIFER R 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	3143	NC
2	103TC0700X	Clinical Psychologist	22739	CA

General Provider Information

NPI Number	:	1912095670
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENNIFER R SHAPIRO PHD

Provider Business Mailing Address
First Line	:	3525 DEL MAR HEIGHTS RD STE 1952
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92130-2199
Country	:	US
Telephone Number	:	619-825-0499
Fax Number	:	888-551-6358

Provider Business Practice Location Address
First Line	:	3525 DEL MAR HEIGHTS RD STE 1952
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92130-2199
Country	:	US
Telephone Number	:	619-825-0499
Fax Number	:	888-551-6358

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

Provider Enumeration Date	:	10/10/2006
Last Update Date	:	03/14/2023

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