Provider Demographics
NPI:1568558872
Name:SHAPIRO, MARLA BETH (PHD, DBSM, HSP)
Entity Type:Individual
Prefix:DR
First Name:MARLA
Middle Name:BETH
Last Name:SHAPIRO
Suffix:
Gender:F
Credentials:PHD, DBSM, HSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1305 SW 7TH ST
Mailing Address - Street 2:
Mailing Address - City:GRIMES
Mailing Address - State:IA
Mailing Address - Zip Code:50111-5185
Mailing Address - Country:US
Mailing Address - Phone:404-494-0658
Mailing Address - Fax:888-598-9466
Practice Address - Street 1:1305 SW 7TH ST
Practice Address - Street 2:
Practice Address - City:GRIMES
Practice Address - State:IA
Practice Address - Zip Code:50111-5185
Practice Address - Country:US
Practice Address - Phone:404-494-0658
Practice Address - Fax:888-598-9466
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-05
Last Update Date:2022-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA098191103G00000X, 103TH0100X, 173F00000X
NE1074103G00000X, 103T00000X, 173F00000X
GAPSY001981103T00000X, 173F00000X, 103G00000X
IA09724103T00000X, 173F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth Service
No173F00000XOther Service ProvidersSleep Specialist, PhD