Provider Demographics
NPI:1366656092
Name:SHANGOLD, HEATHER ROSE (PHD)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:ROSE
Last Name:SHANGOLD
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 1:105 MORRIS AVE
Mailing Address - Street 2:STE. 200
Mailing Address - City:SPRINGFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:07081-1327
Mailing Address - Country:US
Mailing Address - Phone:973-467-3330
Mailing Address - Fax:
Practice Address - Street 1:105 MORRIS AVE
Practice Address - Street 2:STE. 200
Practice Address - City:SPRINGFIELD
Practice Address - State:NJ
Practice Address - Zip Code:07081-1327
Practice Address - Country:US
Practice Address - Phone:973-467-3330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35S100442600103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist