Active NPI
Scott Michael Shapiro
- Clinical Psychologist
- Los Angeles, CA
National Provider Identifier
1609007483
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 25301
- Practice address
- 1145 Gayley Ave
322
Los Angeles, CA 90024-3423 - Phone
- (310) 208-7187
- NPI assigned
- Jul 28, 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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 25301 | CA | Primary |
Addresses
Primary practice location
1145 Gayley Ave
322
Los Angeles, CA 90024-3423
Mailing address
1145 Gayley Avenue
322
Los Angeles, CA 90024
Phone (310) 208-7187
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Feb 13, 2024 through Feb 13, 2028
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 25301 | CA | MD | Rehabilitation Chiropractor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1248739200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1562630400000",
"number": "1609007483",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1145 GAYLEY AVENUE",
"address_2": "322",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "90024",
"telephone_number": "310-208-7187"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1145 GAYLEY AVE",
"address_2": "322",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "900243423",
"telephone_number": "310-208-7187"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHAPIRO",
"first_name": "SCOTT",
"middle_name": "MICHAEL",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2009-07-28",
"last_updated": "2019-07-09",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "CA",
"license": "25301",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 9, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.