Provider Demographics
NPI:1518240480
Name:GILROY, SHAWN PATRICK (EDS, NCSP, BCBA)
Entity Type:Individual
Prefix:MR
First Name:SHAWN
Middle Name:PATRICK
Last Name:GILROY
Suffix:
Gender:M
Credentials:EDS, NCSP, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1711 SPRING GARDEN ST APT 1R
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19130-3930
Mailing Address - Country:US
Mailing Address - Phone:201-317-4098
Mailing Address - Fax:
Practice Address - Street 1:73 OLD EAGLE SCHOOL RD
Practice Address - Street 2:STE. 202
Practice Address - City:WAYNE
Practice Address - State:PA
Practice Address - Zip Code:19087-2524
Practice Address - Country:US
Practice Address - Phone:610-296-6800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-27
Last Update Date:2011-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1-09-5305103K00000X
PA1-09-5305103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst