Provider Demographics
NPI:1063633535
Name:SHAPIRO, JERROLD LEE (PHD)
Entity Type:Individual
Prefix:DR
First Name:JERROLD
Middle Name:LEE
Last Name:SHAPIRO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:385 VERANO DR
Mailing Address - Street 2:
Mailing Address - City:LOS ALTOS
Mailing Address - State:CA
Mailing Address - Zip Code:94022-2345
Mailing Address - Country:US
Mailing Address - Phone:650-948-7292
Mailing Address - Fax:
Practice Address - Street 1:4546 EL CAMINO REAL
Practice Address - Street 2:SUITE 242
Practice Address - City:LOS ALTOS
Practice Address - State:CA
Practice Address - Zip Code:94022-1099
Practice Address - Country:US
Practice Address - Phone:650-941-9219
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY5646103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical