Provider Demographics
NPI:1073530630
Name:SHALOM-CRAIG, GALIT (PSYD)
Entity Type:Individual
Prefix:DR
First Name:GALIT
Middle Name:
Last Name:SHALOM-CRAIG
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:655 CAMELIA LN
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32963-1841
Mailing Address - Country:US
Mailing Address - Phone:772-713-8716
Mailing Address - Fax:772-257-5653
Practice Address - Street 1:655 CAMELIA LN
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32963-1841
Practice Address - Country:US
Practice Address - Phone:772-713-8716
Practice Address - Fax:772-257-5653
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY6510103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL73026OtherBCBS PROVIDER NUMBER
FL73026ZMedicare PIN