Provider Demographics
NPI:1407863830
Name:SHAFARMAN, GAIL (PHD)
Entity Type:Individual
Prefix:DR
First Name:GAIL
Middle Name:
Last Name:SHAFARMAN
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 1:6011 HILLEGASS AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94618-1234
Mailing Address - Country:US
Mailing Address - Phone:510-655-5582
Mailing Address - Fax:510-655-6129
Practice Address - Street 1:1947 FRANCISCO ST
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94709-2123
Practice Address - Country:US
Practice Address - Phone:510-655-5582
Practice Address - Fax:510-655-6129
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2008-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY 14633103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPL146330Medicare PIN