Provider Demographics
NPI:1336642479
Name:SHUMSKY, RON (PSYD)
Entity Type:Individual
Prefix:DR
First Name:RON
Middle Name:
Last Name:SHUMSKY
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 1:1-1-20-110 AZABUDAI
Mailing Address - Street 2:
Mailing Address - City:MINATO-KU
Mailing Address - State:TOKYO
Mailing Address - Zip Code:1830002
Mailing Address - Country:JP
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1-1-20-110 AZABUDAI
Practice Address - Street 2:
Practice Address - City:MINATO-KU
Practice Address - State:TOKYO
Practice Address - Zip Code:1830002
Practice Address - Country:JP
Practice Address - Phone:814-220-7494
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-15
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1638103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT1638OtherPSYCHOLOGY LICENSE