Provider Demographics
NPI:1306276274
Name:SHAPIRO PSYCHOLOGICAL SERVICES, LLC
Entity type:Organization
Organization Name:SHAPIRO PSYCHOLOGICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAPIRO
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:814-308-9048
Mailing Address - Street 1:1402 S ATHERTON ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:STATE COLLEGE
Mailing Address - State:PA
Mailing Address - Zip Code:16801-6255
Mailing Address - Country:US
Mailing Address - Phone:814-308-9048
Mailing Address - Fax:
Practice Address - Street 1:1402 S ATHERTON ST
Practice Address - Street 2:SUITE 102
Practice Address - City:STATE COLLEGE
Practice Address - State:PA
Practice Address - Zip Code:16801-6255
Practice Address - Country:US
Practice Address - Phone:814-308-9048
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-13
Last Update Date:2015-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS017314103G00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty