Active NPI
Lucas Blaine Shaw, PHD
- Clinical Psychologist
- Atascadero, CA
National Provider Identifier
1306138532
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PSY 24101
- Practice address
- 10333 El Camino Real
Atascadero, CA 93422-5808 - Phone
- (805) 468-3612
- Fax
- (805) 468-2910
- NPI assigned
- May 5, 2011
- Sex
- Male
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PSY 24101 | CA | Primary |
Addresses
Primary practice location
10333 El Camino Real
Atascadero, CA 93422-5808
Mailing address
1600 9TH St Ste 205
Sacramento, CA 95814-6435
Phone (916) 654-2431
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 24101 | CA | MD | Clinical Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| State of California - Department of Developmental Services | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Federally Qualified Health Center (FQHC)
- Pomona, CA
- NPI 1093085565
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1304553600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1304553600000",
"number": "1306138532",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1600 9TH ST STE 205",
"city": "SACRAMENTO",
"state": "CA",
"postal_code": "958146435",
"telephone_number": "916-654-2431",
"fax_number": "916-654-3186"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "10333 EL CAMINO REAL",
"city": "ATASCADERO",
"state": "CA",
"postal_code": "934225808",
"telephone_number": "805-468-3612",
"fax_number": "805-468-2910"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHAW",
"first_name": "LUCAS",
"middle_name": "BLAINE",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-05-05",
"last_updated": "2011-05-05",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "PSY 24101",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Atascadero, CA
- Shannon Cantillano Licensed Clinical Social Worker Inc Dba Inner Expansions Therapy Services
- Niranjan Murlidhar Sharma, M.D.
- Stephen Sharp, PHARM.D.
- Siena Kyndal Sharpe
- Shaun Lea Certified Registered Nursing Anesthetist, Inc.
- Stephen G Shaw, M.D.
- Michael Sheedy
- Angie Shenouda, PSY.D.
- Jeffrey Clinton Shepherd, D.D.S.
- Breanna Jo Sheppard, SUDRC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 5, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.