Provider Demographics
NPI:1699952796
Name:SHAW, ZOE MIRANDA (PSYD)
Entity type:Individual
Prefix:DR
First Name:ZOE
Middle Name:MIRANDA
Last Name:SHAW
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3053 RANCHO VISTA BLVD
Mailing Address - Street 2:SUITE H #114
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93551-4823
Mailing Address - Country:US
Mailing Address - Phone:661-718-2694
Mailing Address - Fax:661-718-2694
Practice Address - Street 1:3053 RANCHO VISTA BLVD
Practice Address - Street 2:SUITE H #114
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551-4823
Practice Address - Country:US
Practice Address - Phone:661-718-2694
Practice Address - Fax:661-718-2694
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-30
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT39636106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist