Individual
DR. CAROLYN B. SHADDUCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PH.D., PSY.D.
Contact information
Practice address
636 26TH ST, SANTA MONICA, CA 90402-3148
(310) 395-0436
(310) 395-1887
Mailing address
636 26TH ST, SANTA MONICA, CA 90402-3148
(310) 395-0436
(310) 395-1887
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PSY4871
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PSY4871
LICENSE AS A PSYCHOLOGIST
CA
Enumeration date
07/13/2006
Last updated
07/08/2007
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