Provider Demographics
NPI:1437788577
Name:SHAFRAN, MARINA (PHD)
Entity Type:Individual
Prefix:
First Name:MARINA
Middle Name:
Last Name:SHAFRAN
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 1:219 LAMPLIGHT LN
Mailing Address - Street 2:
Mailing Address - City:LEWISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17837-9788
Mailing Address - Country:US
Mailing Address - Phone:570-768-1632
Mailing Address - Fax:
Practice Address - Street 1:219 LAMPLIGHT LN
Practice Address - Street 2:
Practice Address - City:LEWISBURG
Practice Address - State:PA
Practice Address - Zip Code:17837-9788
Practice Address - Country:US
Practice Address - Phone:570-768-1632
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-01
Last Update Date:2020-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist