Provider Demographics
NPI:1518311232
Name:SHAW, LYNDI ELIZABETH (MA)
Entity Type:Individual
Prefix:
First Name:LYNDI
Middle Name:ELIZABETH
Last Name:SHAW
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:SHAW
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA
Mailing Address - Street 1:2830 I ST
Mailing Address - Street 2:STE 306
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-4311
Mailing Address - Country:US
Mailing Address - Phone:916-722-7792
Mailing Address - Fax:
Practice Address - Street 1:2830 I ST
Practice Address - Street 2:STE 306
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-4311
Practice Address - Country:US
Practice Address - Phone:916-722-7792
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-19
Last Update Date:2016-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSB 94022177103TA0400X, 101YM0800X, 103TA0700X, 103TB0200X, 103TC0700X, 103TC1900X, 103TC2200X, 103TF0000X, 103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103TA0700XBehavioral Health & Social Service ProvidersPsychologistAdult Development & Aging
No103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral
No103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily
No103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup Psychotherapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSB 94022177OtherBOARD OF PSYCHOLOGY