Provider Demographics
NPI:1154647345
Name:DR ELIZABETH SHON, PSYCHOLOGICAL SERVICES INC.
Entity Type:Organization
Organization Name:DR ELIZABETH SHON, PSYCHOLOGICAL SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:K
Authorized Official - Last Name:SHON
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:626-793-0858
Mailing Address - Street 1:745 S MARENGO AVE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91106-4735
Mailing Address - Country:US
Mailing Address - Phone:626-793-0858
Mailing Address - Fax:323-256-8203
Practice Address - Street 1:745 S MARENGO AVE
Practice Address - Street 2:SUITE 105
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91106-4735
Practice Address - Country:US
Practice Address - Phone:626-793-0858
Practice Address - Fax:323-256-8203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-13
Last Update Date:2010-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY11520103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAX515Medicare PIN