Provider Demographics
NPI:1053734947
Name:SHAPIRO, SHANNON (LMFT)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:SHAPIRO
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3820 GEORGIA ST APT 7
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-7623
Mailing Address - Country:US
Mailing Address - Phone:520-240-1869
Mailing Address - Fax:
Practice Address - Street 1:3820 GEORGIA ST APT 7
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-7623
Practice Address - Country:US
Practice Address - Phone:520-240-1869
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-28
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA129076106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist