Provider Demographics
NPI:1487706248
Name:SHON, ELIZABETH (PHD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:
Last Name:SHON
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 1:745 S MARENGO AVE
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91106-4735
Mailing Address - Country:US
Mailing Address - Phone:626-793-0858
Mailing Address - Fax:323-256-8203
Practice Address - Street 1:745 S MARENGO AVE
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91106-4735
Practice Address - Country:US
Practice Address - Phone:626-793-0858
Practice Address - Fax:323-256-8203
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY11520103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist