Provider Demographics
NPI:1518261494
Name:KATHERINE SHACHAR, PH..D., INC.
Entity Type:Organization
Organization Name:KATHERINE SHACHAR, PH..D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:KATHERINE
Authorized Official - Middle Name:BOHAN
Authorized Official - Last Name:SHACHAR
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:949-999-0857
Mailing Address - Street 1:260 NEWPORT CENTER DR
Mailing Address - Street 2:402
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-7520
Mailing Address - Country:US
Mailing Address - Phone:949-999-0857
Mailing Address - Fax:949-721-5886
Practice Address - Street 1:260 NEWPORT CENTER DR
Practice Address - Street 2:402
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-7520
Practice Address - Country:US
Practice Address - Phone:949-999-0857
Practice Address - Fax:949-721-5886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-06
Last Update Date:2011-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY17620103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty