Doctor Name: | STUART M SHAFFER |
NPI Number: | 1366588675 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | PH.D. |
License Number: | PSY5613 |
Business Practice Address: | 4640 Admiralty Way Suite 318 Marina Del Rey, CA - 902926621 |
Business Phone Number: | 3108220109 |
Business Fax Number: | 3108221240 |
Mailing Address: | 4640 Admiralty Way, Suite 318 MARINA DEL REY |
State: | CA |
Postal Code: | 902926621 |
Phone Number: | 3108220109 |
Fax Number: | 3108221240 |
NPI Enumeration Date: | 01/30/2007 |
NPI Last Update Date: | 03/20/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103G00000X |
License Number: | PSY5613 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | CA |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Clinical Neuropsychologist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual with a doctorate degree, licensure in clinical psychology and specialized training or board certification in neuropsychology who practices or adheres to the principles of neuropsychology; a specialty within the field of psychology focusing primarily on neurobehavioral functioning. |