Provider Demographics
NPI:1992011126
Name:IMPELLIZZERI, SHIRLEY (PHD)
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:
Last Name:IMPELLIZZERI
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 1:9454 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 301
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90212-2931
Mailing Address - Country:US
Mailing Address - Phone:310-859-1102
Mailing Address - Fax:310-859-3503
Practice Address - Street 1:9454 WILSHIRE BLVD
Practice Address - Street 2:SUITE 301
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90212-2931
Practice Address - Country:US
Practice Address - Phone:310-859-1102
Practice Address - Fax:310-859-3503
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-25
Last Update Date:2010-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY17322103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical