Provider Demographics
NPI:1174643035
Name:SHELLEY CHERNOFF KRAMER, PH.D., INC., CLINICAL PSYCHOLOGY
Entity Type:Organization
Organization Name:SHELLEY CHERNOFF KRAMER, PH.D., INC., CLINICAL PSYCHOLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SHELLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:KRAMER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:760-966-1286
Mailing Address - Street 1:2181 S EL CAMINO REAL
Mailing Address - Street 2:SUITE 305
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92054-6220
Mailing Address - Country:US
Mailing Address - Phone:760-966-1286
Mailing Address - Fax:760-966-1911
Practice Address - Street 1:2181 S EL CAMINO REAL
Practice Address - Street 2:STE 305
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92054-6288
Practice Address - Country:US
Practice Address - Phone:760-966-1286
Practice Address - Fax:760-966-1911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-01
Last Update Date:2012-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY4219103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP4219AOtherMEDICARE PTAN
CACP4219AMedicare PIN
CACP4219AMedicare ID - Type UnspecifiedPSYCHOLOGIST