Provider Demographics
NPI:1962601732
Name:MAYFIELD, SHIRLEY ANN (MA, PHD)
Entity type:Individual
Prefix:DR
First Name:SHIRLEY
Middle Name:ANN
Last Name:MAYFIELD
Suffix:
Gender:F
Credentials:MA, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:725 ASHBURY AVE
Mailing Address - Street 2:
Mailing Address - City:EL CERRITO
Mailing Address - State:CA
Mailing Address - Zip Code:94530-3247
Mailing Address - Country:US
Mailing Address - Phone:510-225-5788
Mailing Address - Fax:
Practice Address - Street 1:902 CARMEL AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:CA
Practice Address - Zip Code:94706-2106
Practice Address - Country:US
Practice Address - Phone:510-225-5788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-12
Last Update Date:2014-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15032103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA09347Medicaid