Provider Demographics
NPI:1609535087
Name:NEWMAN, SHANLEY (PSYD)
Entity Type:Individual
Prefix:
First Name:SHANLEY
Middle Name:
Last Name:NEWMAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2601 AIRPORT DR STE 135
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-6141
Mailing Address - Country:US
Mailing Address - Phone:424-337-0370
Mailing Address - Fax:
Practice Address - Street 1:1000 WILSHIRE BLVD # 240
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-2457
Practice Address - Country:US
Practice Address - Phone:424-201-1600
Practice Address - Fax:424-201-1601
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-13
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSB94026387103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical