Shirley Joanne Blair, PSY.D.
Individual provider Active NPI Clinical Psychologist · Little River, CA
NPI 1487862041 · NPPES record last updated Jul 8, 2007
Key facts
- NPI
- 1487862041
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Clinical Psychologist 103TC0700X
- License
- PSY21383 (CA)
- Practice address
- 33200 Frog Pond Road
Little River, CA 95456 - Phone
- (707) 972-2048
- NPI assigned
- May 18, 2007
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PSY21383 | CA | MD | Clinical Psychologist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | PSY21383 | CA | Yes |
Addresses
Primary practice location
33200 Frog Pond Road
Little River, CA 95456
Mailing address
PO Box 376
Little River, CA 95456-0376
Phone (707) 937-3992
Other providers in Little River, CA
All providers in Little River, CA · Clinical Psychologist in California
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 8, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.