Provider Demographics
NPI:1467596510
Name:SHAK, GAIL M (PHD)
Entity Type:Individual
Prefix:DR
First Name:GAIL
Middle Name:M
Last Name:SHAK
Suffix:
Gender:F
Credentials:PHD
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Mailing Address - Street 1:405 PRIMROSE RD
Mailing Address - Street 2:SUITE 205
Mailing Address - City:BURLINGAME
Mailing Address - State:CA
Mailing Address - Zip Code:94010-4064
Mailing Address - Country:US
Mailing Address - Phone:650-375-1588
Mailing Address - Fax:650-548-1589
Practice Address - Street 1:405 PRIMROSE RD
Practice Address - Street 2:SUITE 205
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-4064
Practice Address - Country:US
Practice Address - Phone:650-375-1588
Practice Address - Fax:650-548-1589
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPSY10401103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling