Provider Demographics
NPI:1912095670
Name:SHAPIRO, JENNIFER R (PHD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:R
Last Name:SHAPIRO
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 1:3525 DEL MAR HEIGHTS RD STE 1952
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92130-2199
Mailing Address - Country:US
Mailing Address - Phone:619-825-0499
Mailing Address - Fax:888-551-6358
Practice Address - Street 1:3525 DEL MAR HEIGHTS RD STE 1952
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130-2199
Practice Address - Country:US
Practice Address - Phone:619-825-0499
Practice Address - Fax:888-551-6358
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC3143103TC0700X
CA22739103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical