Provider Demographics
NPI:1689179731
Name:SHAPIRO, ERICA ROSENTRAUB (PHD)
Entity Type:Individual
Prefix:
First Name:ERICA
Middle Name:ROSENTRAUB
Last Name:SHAPIRO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:ERICA
Other - Middle Name:
Other - Last Name:ROSENTRAUB
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4040 BROADWAY SUITE 518
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78209
Mailing Address - Country:US
Mailing Address - Phone:210-858-1900
Mailing Address - Fax:210-745-4525
Practice Address - Street 1:1314 E. SONTERRA BLVD. STE. 2208
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78258
Practice Address - Country:US
Practice Address - Phone:210-858-1900
Practice Address - Fax:210-745-4525
Is Sole Proprietor?:No
Enumeration Date:2018-03-29
Last Update Date:2018-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX36986103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist