MARILYN A SHORE, PHD - NPI NUMBER 1598844847

Summary

Provider Name: MARILYN A SHORE, PHD

NPI Number: 1598844847

Clasification: Psychologist (103T00000X)

Address:
2659 TOWNSGATE ROAD
SUITE 201
WESTLAKE VILLAGE, CA
ZIP 91361

Phone Number: (805) 494-1484



Detailed Information

Marilyn A Shore, PHD is a psychologist in Westlake Village, CA with 29 years of experience. The provider is a psychologist is an individual who is licensed to practice psychology which is defined as the observation, description, evaluation, interpretation, and modification of human behavior by the application of psychological principles, methods, and procedures, for the purpose of preventing or eliminating symptomatic, maladaptive, or undesired behavior and of enhancing interpersonal relationships, work and life adjustment, personal effectiveness, behavioral health, and mental health. The practice of psychology includes, but is not limited to, psychological testing and the evaluation or assessment of personal characteristics, such as intelligence, personality, abilities, interests, aptitudes, and neuropsychological functioning; counseling, psychoanalysis, psychotherapy, hypnosis, biofeedback, and behavior analysis and therapy; diagnosis and treatment of mental and emotional disorder or disability, alcoholism and substance abuse, disorders of habit or conduct, as well as of the psychological aspects of physical illness, accident, injury, or disability; and psycheducational evaluation, therapy, remediation, and consultation. Psychological services may be rendered to individuals, families, groups and the public. The assigned NPI number for this provider is 1598844847 and is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business address is:

2659 TOWNSGATE ROAD
SUITE 201
WESTLAKE VILLAGE, CA
ZIP 91361
Phone: (805) 494-1484
Fax: (805) 494-9677

The enumeration date for this NPI number is 11/6/2006 and was last updated on 7/8/2007.

Map - Location of Practice

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Taxonomy Codes

The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1 103T00000X Psychologist PS411866 CA Yes

Other (Legacy) Identifiers

The following legacy identifiers are available for this provider:

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
1 R27451 MEDICARE UPIN
2 CP11866 MEDICARE ID-TYPE UNSPECIFIED CA

NPI Record

No. Field Name Field Value
1 NPI 1598844847
2 Entity Type Code 1
3 Provider Last Name Legal Name SHORE
4 Provider First Name MARILYN
5 Provider Middle Name A
6 Provider Credential Text PHD
7 Provider First Line Business Practice Location Address 2659 TOWNSGATE ROAD
8 Provider Second Line Business Practice Location Address SUITE 201
9 Provider Business Practice Location Address City Name WESTLAKE VILLAGE
10 Provider Business Practice Location Address State Name CA
11 Provider Business Practice Location Address Postal Code 91361
12 Provider Business Practice Location Address Country Code If outside U S US
13 Provider Business Practice Location Address Telephone Number 8054941484
14 Provider Business Practice Location Address Fax Number 8054949677
15 Provider Enumeration Date 11/6/2006
16 Last Update Date 7/8/2007
17 Provider Gender Code F
18 Healthcare Provider Taxonomy Code 1 103T00000X
19 Provider License Number 1 PS411866
20 Provider License Number State Code 1 CA
21 Healthcare Provider Primary Taxonomy Switch 1 Y
22 Other Provider Identifier 1 R27451
23 Other Provider Identifier Type Code 1 02
24 Other Provider Identifier 2 CP11866
25 Other Provider Identifier Type Code 2 04
26 Other Provider Identifier State 2 CA
27 Is Sole Proprietor N

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This page was last updated on: 7/15/2014
All materials and services on this site are provided on an "as is" and "as available" basis without warranty of any kind. The NPI record is maintained by the National Plan & Provider Enumeration System (NPPES) and anyone may request this information and other NPPES health care provider data from HHS under The Freedom of Information Act (FOIA), Title 5 of the United States Code, section 552. To update the NPI records please contact the NPPES.