Provider Demographics
NPI:1154986370
Name:SHUM, EMILY WEAR (PHD)
Entity type:Individual
Prefix:
First Name:EMILY
Middle Name:WEAR
Last Name:SHUM
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:ANNE
Other - Last Name:WEAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10601 CIVIC CENTER DR STE 150
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91730-7682
Mailing Address - Country:US
Mailing Address - Phone:909-293-9124
Mailing Address - Fax:
Practice Address - Street 1:10601 CIVIC CENTER DR STE 150
Practice Address - Street 2:
Practice Address - City:RANCHO CUCAMONGA
Practice Address - State:CA
Practice Address - Zip Code:91730-7682
Practice Address - Country:US
Practice Address - Phone:909-293-9124
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-02
Last Update Date:2022-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY30752103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist