Provider Demographics
NPI:1326187139
Name:SHAPIRO, SUSAN ABBY (PH D)
Entity Type:Individual
Prefix:DR
First Name:SUSAN
Middle Name:ABBY
Last Name:SHAPIRO
Suffix:
Gender:F
Credentials:PH D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:120 SEARS AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40207-5072
Mailing Address - Country:US
Mailing Address - Phone:502-893-5332
Mailing Address - Fax:502-893-5764
Practice Address - Street 1:120 SEARS AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-5072
Practice Address - Country:US
Practice Address - Phone:502-893-5332
Practice Address - Fax:502-893-5764
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY526103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1278968OtherTAX ID