Provider Demographics
NPI:1447540299
Name:SHAPIN, BONNY (PHD)
Entity type:Individual
Prefix:DR
First Name:BONNY
Middle Name:
Last Name:SHAPIN
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 1:175 S COLLEGE AVE
Mailing Address - Street 2:
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711-5003
Mailing Address - Country:US
Mailing Address - Phone:909-921-3828
Mailing Address - Fax:909-624-6796
Practice Address - Street 1:415 W FOOTHILL BLVD STE 212
Practice Address - Street 2:
Practice Address - City:CLAREMONT
Practice Address - State:CA
Practice Address - Zip Code:91711-2780
Practice Address - Country:US
Practice Address - Phone:909-921-3828
Practice Address - Fax:888-433-3022
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-13
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18643103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical