Provider Demographics
NPI:1497039333
Name:MCKINSEY, SHAYNE (PHD, LPC)
Entity Type:Individual
Prefix:DR
First Name:SHAYNE
Middle Name:
Last Name:MCKINSEY
Suffix:
Gender:F
Credentials:PHD, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5 WITHERS LN
Mailing Address - Street 2:
Mailing Address - City:ATLANTIC HIGHLANDS
Mailing Address - State:NJ
Mailing Address - Zip Code:07716-2248
Mailing Address - Country:US
Mailing Address - Phone:732-768-0612
Mailing Address - Fax:
Practice Address - Street 1:5 WITHERS LN
Practice Address - Street 2:
Practice Address - City:ATLANTIC HIGHLANDS
Practice Address - State:NJ
Practice Address - Zip Code:07716-2248
Practice Address - Country:US
Practice Address - Phone:732-768-0612
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-10
Last Update Date:2011-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ37PC00311200101YP2500X, 103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional