Provider Demographics
NPI:1568841047
Name:SHAPIRO, ELIZABETH (LAMFT)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:SHAPIRO
Suffix:
Gender:F
Credentials:LAMFT
Other - Prefix:
Other - First Name:ELIZABETH
Other - Middle Name:
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LAMFT
Mailing Address - Street 1:2048 LOWER SAINT DENNIS RD
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55116-2833
Mailing Address - Country:US
Mailing Address - Phone:612-790-2205
Mailing Address - Fax:
Practice Address - Street 1:1684 SELBY AVE
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-6149
Practice Address - Country:US
Practice Address - Phone:612-790-2205
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-29
Last Update Date:2015-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN2513106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist