Stuart M Shaffer, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

PSY5613 Issued in CA

Practice address

753 W Basin St
San Pedro, CA 90731-1301

Phone

(310) 548-6868

Fax

(310) 548-6833

NPI assigned

Jan 30, 2007

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

Other, 1967

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

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.

• Marina Psychological Services

  • Psychologist
  • Marina del Rey, CA
  • NPI 1912043233
  NPD (past) Authorized official
• Shaffer Psychological Institute

  • Psychologist
  • San Pedro, CA
  • NPI 1629115415
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170115200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1709596800000",
    "number": "1366588675",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "753 W BASIN ST",
            "city": "SAN PEDRO",
            "state": "CA",
            "postal_code": "907311301",
            "telephone_number": "310-548-6868",
            "fax_number": "310-548-6833"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "753 W BASIN ST",
            "city": "SAN PEDRO",
            "state": "CA",
            "postal_code": "907311301",
            "telephone_number": "310-548-6868",
            "fax_number": "310-548-6833"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHAFFER",
        "first_name": "STUART",
        "middle_name": "M",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-01-30",
        "last_updated": "2024-03-05",
        "certification_date": "2024-03-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "CA",
            "license": "PSY5613",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "PSY5613",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Serenity Villa Jja, Inc
• Michelle Lynn Sereno
• Elizabeth Servaites, NP
• Tara Lynn Shafer, FNP
• Shaffer Psychological Institute
• Krupa Shah, M.D.
• Mona S Shah, MD
• Shamrock Healthcare Services
• Grant Shandler, D.D.S.
• Leilani M. Sharpe, M.D., PH.D.

• Clinical Psychologist in San Pedro, CA
• Providers in San Pedro, CA by specialty
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.