Provider Demographics
NPI:1326120874
Name:SHAPIRO, ELSA GAIL (PHD)
Entity Type:Individual
Prefix:
First Name:ELSA
Middle Name:GAIL
Last Name:SHAPIRO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:ELSA
Other - Middle Name:GAIL
Other - Last Name:GREENBERG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:420 DELAWARE STREET SE
Mailing Address - Street 2:UNIVERSITY OF MINNESOTA PHYSICIANS
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455
Mailing Address - Country:US
Mailing Address - Phone:612-625-7466
Mailing Address - Fax:
Practice Address - Street 1:516 DELAWARE ST SE
Practice Address - Street 2:PWB FOURTH FLOOR, ROOM 4-100
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455-0356
Practice Address - Country:US
Practice Address - Phone:612-625-7466
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNLP1851103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
B696OtherCHAMPUS
MNHP28933OtherHEALTH PARTNERS
FM102843OtherUCARE
MN770292OtherARAZ
C003OtherCHAMPUS
MN61-80321OtherMEDICA CHOICE
MN4T525SHOtherBLUE CROSS BLUE SHIELD
MT0491895Medicaid
MN1016466OtherPREFERRED ONE