Provider Demographics
NPI:1861877292
Name:SHAPIRO, MIRIAM (PHD)
Entity type:Individual
Prefix:
First Name:MIRIAM
Middle Name:
Last Name:SHAPIRO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1608 ADELIA PL NE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30329-3808
Mailing Address - Country:US
Mailing Address - Phone:314-440-6175
Mailing Address - Fax:770-933-4135
Practice Address - Street 1:2400 LAKE PARK DR SE STE 110
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:GA
Practice Address - Zip Code:30080-8979
Practice Address - Country:US
Practice Address - Phone:770-933-4130
Practice Address - Fax:770-933-4135
Is Sole Proprietor?:No
Enumeration Date:2015-07-27
Last Update Date:2023-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAPSY004028103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical