Provider Demographics
NPI:1093233652
Name:SHIPLEY, PAMELA COREY (LPC)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:COREY
Last Name:SHIPLEY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 RODNEY PLACE
Mailing Address - Street 2:
Mailing Address - City:DEMAREST
Mailing Address - State:NJ
Mailing Address - Zip Code:07627
Mailing Address - Country:US
Mailing Address - Phone:201-673-7911
Mailing Address - Fax:
Practice Address - Street 1:1485 TEANECK RD
Practice Address - Street 2:
Practice Address - City:TEANECK
Practice Address - State:NJ
Practice Address - Zip Code:07666-3626
Practice Address - Country:US
Practice Address - Phone:201-837-9090
Practice Address - Fax:201-837-9393
Is Sole Proprietor?:No
Enumeration Date:2017-09-05
Last Update Date:2017-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00565900101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health