Provider Demographics
NPI:1548483613
Name:SHECK, ADAM MAURY (PSYD)
Entity type:Individual
Prefix:DR
First Name:ADAM
Middle Name:MAURY
Last Name:SHECK
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6381 W 6TH ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-4805
Mailing Address - Country:US
Mailing Address - Phone:310-968-1526
Mailing Address - Fax:
Practice Address - Street 1:6381 W 6TH ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-4805
Practice Address - Country:US
Practice Address - Phone:310-968-1526
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY15487103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACP15487Medicare ID - Type UnspecifiedPROVIDER NUMBER