Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 102L00000X | Psychologist | 0810004435 | VA |
N | 103T00000X | Psychologist | 0810004435 | VA |
N | 103TB0200X | Cognitive & Behavioral Psychologist | 0810004435 | VA |
N | 103G00000X | Clinical Psychologist | 0810004435 | VA |
N | 103TC0700X | Clinical Psychologist | 0810004435 | VA |
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | 0810004435 | VA |
N | 103TF0000X | Family Psychologist | 0810004435 | VA |
N | 103TS0200X | School Psychologist | 0810004435 | VA |
NPI | 1043508054 |
---|---|
Provider Name | Dr. Shawn Gewirtz |
First Address | Charlottesville, VA 22902-7218 |
Second Address | Charlottesville, VA 22903-6500 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/07/2011 |
Last Update Date | 12/07/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1942270699 | (05) | VA |