Provider Demographics
NPI:1801821764
Name:SHAPIRO, TERRY HARLAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:TERRY
Middle Name:HARLAN
Last Name:SHAPIRO
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:477 E BUTTERFIELD RD
Mailing Address - Street 2:SUITE LL005
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-5618
Mailing Address - Country:US
Mailing Address - Phone:630-699-2868
Mailing Address - Fax:630-426-0470
Practice Address - Street 1:477 E BUTTERFIELD RD
Practice Address - Street 2:SUITE LL005
Practice Address - City:LOMBARD
Practice Address - State:IL
Practice Address - Zip Code:60148-5618
Practice Address - Country:US
Practice Address - Phone:630-699-2868
Practice Address - Fax:630-426-0470
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical