Provider Demographics
NPI:1144284126
Name:SCHELLENBERG, DIANNE E (PSYD)
Entity type:Individual
Prefix:DR
First Name:DIANNE
Middle Name:E
Last Name:SCHELLENBERG
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:630 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18018-5232
Mailing Address - Country:US
Mailing Address - Phone:610-868-5424
Mailing Address - Fax:
Practice Address - Street 1:2045 WESTGATE DR
Practice Address - Street 2:SUITE 304
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18017-7480
Practice Address - Country:US
Practice Address - Phone:610-865-8177
Practice Address - Fax:610-865-2764
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPC004025OtherLICENSE NUMBER