Provider Demographics
NPI:1114056660
Name:SHUSTER, NANCY MACLACHLAN (PHD)
Entity Type:Individual
Prefix:DR
First Name:NANCY
Middle Name:MACLACHLAN
Last Name:SHUSTER
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 1:41 PEARL ST
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:NY
Mailing Address - Zip Code:12401-4552
Mailing Address - Country:US
Mailing Address - Phone:845-338-3422
Mailing Address - Fax:845-687-0814
Practice Address - Street 1:41 PEARL ST
Practice Address - Street 2:
Practice Address - City:KINGSTON
Practice Address - State:NY
Practice Address - Zip Code:12401-4552
Practice Address - Country:US
Practice Address - Phone:845-338-3422
Practice Address - Fax:845-687-0814
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010976103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYS10976-9OtherWORKER COMPENSATION BOARD