Provider Demographics
NPI:1326574609
Name:SHILLABEER, RICHARD (PSYD)
Entity Type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:
Last Name:SHILLABEER
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:155 COLUMBIA ST
Mailing Address - Street 2:
Mailing Address - City:DURYEA
Mailing Address - State:PA
Mailing Address - Zip Code:18642-1403
Mailing Address - Country:US
Mailing Address - Phone:570-466-5870
Mailing Address - Fax:
Practice Address - Street 1:155 COLUMBIA ST
Practice Address - Street 2:
Practice Address - City:DURYEA
Practice Address - State:PA
Practice Address - Zip Code:18642-1403
Practice Address - Country:US
Practice Address - Phone:570-466-5870
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-05
Last Update Date:2017-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC005087101YM0800X
CALEP3615103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool