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

Table of content: (NPI 1174643035)

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".




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