Provider Demographics
NPI:1760849574
Name:MAOR, SHAI (BA)
Entity Type:Individual
Prefix:MR
First Name:SHAI
Middle Name:
Last Name:MAOR
Suffix:
Gender:M
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:512 S HOBART BLVD
Mailing Address - Street 2:APT. 503
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90020-3748
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1555 N VERDUGO RD
Practice Address - Street 2:UNIT 201
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91208-2839
Practice Address - Country:US
Practice Address - Phone:213-278-0500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-01-25
Last Update Date:2016-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA251C0000X103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst