Active NPI
Mark M. Shaw, PH.D.
- Forensic Psychologist
- Vacaville, CA
National Provider Identifier
1154556918
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Forensic Psychologist
- License
- PSY 15079
- Practice address
- 1600 California Dr
Vacaville, CA 95687 - Phone
- (707) 449-6504
- Fax
- (707) 453-7047
- NPI assigned
- May 22, 2009
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Forensic Psychologist | 103TF0200X | PSY 15079 | CA | Primary |
Addresses
Primary practice location
1600 California Dr
Vacaville, CA 95687
Mailing address
PO Box 9811
Berkeley, CA 94709-0811
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY 15079 | CA | MD | Forensic Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1242950400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1242950400000",
"number": "1154556918",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 9811",
"city": "BERKELEY",
"state": "CA",
"postal_code": "947090811"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1600 CALIFORNIA DR",
"city": "VACAVILLE",
"state": "CA",
"postal_code": "95687",
"telephone_number": "707-449-6504",
"fax_number": "707-453-7047"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHAW",
"first_name": "MARK",
"middle_name": "M.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-05-22",
"last_updated": "2009-05-22",
"status": "A"
},
"taxonomies": [
{
"code": "103TF0200X",
"taxonomy_group": "",
"desc": "Psychologist, Forensic",
"state": "CA",
"license": "PSY 15079",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Vacaville, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 22, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.