1487277752 NPI number — SHALE PSYCHOLOGY, LLC

Table of content: (NPI 1487277752)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487277752 NPI number — SHALE PSYCHOLOGY, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SHALE PSYCHOLOGY, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1487277752
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/21/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
574 WAYNE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RIVER VALE
Provider Business Mailing Address State Name:
NJ
Provider Business Mailing Address Postal Code:
07675-6160
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
201-370-1570
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
82 E ALLENDALE RD STE 2B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SADDLE RIVER
Provider Business Practice Location Address State Name:
NJ
Provider Business Practice Location Address Postal Code:
07458-3057
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
201-477-8178
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/21/2020

Additional Information

Authorized Official

Authorized Official Last Name:
SHALE DEUTSCH
Authorized Official First Name:
ALLISON
Authorized Official Middle Name:
Authorized Official Title or Position:
PSYCHOLOGIST
Authorized Official Telephone Number:
201-477-8178

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1982956132 . This is a "ANDRUS" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com