Provider Demographics
NPI:1225268329
Name:ALBARELLI, SHANNON (PSYD)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:ALBARELLI
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 1:100 WILSON RD
Mailing Address - Street 2:APT. 92
Mailing Address - City:SPRINGFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07081-2175
Mailing Address - Country:US
Mailing Address - Phone:617-216-5886
Mailing Address - Fax:
Practice Address - Street 1:7 UNION PL
Practice Address - Street 2:
Practice Address - City:SUMMIT
Practice Address - State:NJ
Practice Address - Zip Code:07901-3656
Practice Address - Country:US
Practice Address - Phone:973-544-8067
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-23
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TH0004XBehavioral Health & Social Service ProvidersPsychologistHealth
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ181717V6ZMedicare PIN