Basic Information
| Provider Information | |||||||||
| NPI: | 1588723605 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SHAPIRO | ||||||||
| FirstName: | IDEE | ||||||||
| MiddleName: | B | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | LMFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 895 NAPA AVE. | ||||||||
| Address2: | SUITE B-6 | ||||||||
| City: | MORRO BAY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 93442 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8057814725 | ||||||||
| FaxNumber: | 8057814726 | ||||||||
| Practice Location | |||||||||
| Address1: | 895 NAPA AVE. | ||||||||
| Address2: | SUITE B-6 | ||||||||
| City: | MORRO BAY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 93442 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8057814725 | ||||||||
| FaxNumber: | 8057814726 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/06/2006 | ||||||||
| LastUpdateDate: | 06/09/2016 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 106H00000X | MFT39394 | CA | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.