Provider Demographics
NPI:1336320233
Name:SHALLER, ESME ALEXANDRA LONDAHL (PHD)
Entity Type:Individual
Prefix:DR
First Name:ESME
Middle Name:ALEXANDRA LONDAHL
Last Name:SHALLER
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:ESME
Other - Middle Name:ALEXANDRA
Other - Last Name:LONDAHL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:401 PARNASSUS AVE
Mailing Address - Street 2:BOX 0984-- CAS
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94143-2211
Mailing Address - Country:US
Mailing Address - Phone:415-476-7350
Mailing Address - Fax:
Practice Address - Street 1:401 PARNASSUS AVE
Practice Address - Street 2:BOX 0984-- CAS
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-2211
Practice Address - Country:US
Practice Address - Phone:415-476-7350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-19
Last Update Date:2007-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 21682103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent