Provider Demographics
NPI:1790902583
Name:SHEA, HERMINIA E (PHD)
Entity Type:Individual
Prefix:DR
First Name:HERMINIA
Middle Name:E
Last Name:SHEA
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18652 FLORIDA ST STE 230
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-6007
Mailing Address - Country:US
Mailing Address - Phone:714-847-4415
Mailing Address - Fax:714-791-8792
Practice Address - Street 1:18652 FLORIDA ST STE 230
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-6007
Practice Address - Country:US
Practice Address - Phone:714-847-4415
Practice Address - Fax:714-791-8792
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY13044103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP13044Medicare ID - Type UnspecifiedPSYCHOLOGIST