1174643035 NPI number — SHELLEY CHERNOFF KRAMER, PH.D., INC., CLINICAL PSYCHOLOGY

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174643035 NPI number — SHELLEY CHERNOFF KRAMER, PH.D., INC., CLINICAL PSYCHOLOGY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHELLEY CHERNOFF KRAMER, PH.D., INC., CLINICAL PSYCHOLOGY
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1174643035
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/13/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2181 S EL CAMINO REAL
Provider Second Line Business Mailing Address:
SUITE 305
Provider Business Mailing Address City Name:
OCEANSIDE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92054-6220
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-966-1286
Provider Business Mailing Address Fax Number:
760-966-1911

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2181 S EL CAMINO REAL
Provider Second Line Business Practice Location Address:
STE 305
Provider Business Practice Location Address City Name:
OCEANSIDE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92054-6288
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-966-1286
Provider Business Practice Location Address Fax Number:
760-966-1911
Provider Enumeration Date:
04/01/2007

Additional Information

Authorized Official

Authorized Official Last Name:
KRAMER
Authorized Official First Name:
SHELLEY
Authorized Official Middle Name:
Authorized Official Title or Position:
PSYCHOLOGIST
Authorized Official Telephone Number:
760-966-1286

Provider Taxonomy Codes

  • Taxonomy code: 103TC0700X , with the licence number:  PSY4219 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: CP4219A . This is a "MEDICARE PTAN" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com