Provider Demographics
NPI:1497144661
Name:ELLEN SHAPIRO LLC
Entity Type:Organization
Organization Name:ELLEN SHAPIRO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER/PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAPIRO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:850-556-2625
Mailing Address - Street 1:1003 N ADAMS ST
Mailing Address - Street 2:
Mailing Address - City:TALLAHASSEE
Mailing Address - State:FL
Mailing Address - Zip Code:32303-6132
Mailing Address - Country:US
Mailing Address - Phone:850-222-0003
Mailing Address - Fax:850-222-1311
Practice Address - Street 1:1003 N ADAMS ST
Practice Address - Street 2:
Practice Address - City:TALLAHASSEE
Practice Address - State:FL
Practice Address - Zip Code:32303-6132
Practice Address - Country:US
Practice Address - Phone:850-222-0003
Practice Address - Fax:850-222-1311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-12
Last Update Date:2015-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY 3674103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL75835Medicare UPIN