Provider Demographics
NPI:1245400340
Name:SHENFELD, MIRIAM ELISE (PHD)
Entity Type:Individual
Prefix:DR
First Name:MIRIAM
Middle Name:ELISE
Last Name:SHENFELD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5014 COMMONWEALTH AVE
Mailing Address - Street 2:
Mailing Address - City:LA CANADA
Mailing Address - State:CA
Mailing Address - Zip Code:91011-2402
Mailing Address - Country:US
Mailing Address - Phone:818-952-9400
Mailing Address - Fax:
Practice Address - Street 1:260 S LOS ROBLES AVE
Practice Address - Street 2:STE 102
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91101-2824
Practice Address - Country:US
Practice Address - Phone:818-952-9400
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-04
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY9921103T00000X, 103TC0700X, 261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical