Provider Demographics
NPI:1558097600
Name:SHELLEY ROSEN THERAPY PLLC
Entity Type:Organization
Organization Name:SHELLEY ROSEN THERAPY PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:SHELLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:WALKER ROSEN
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:207-699-8674
Mailing Address - Street 1:50 MARKET ST
Mailing Address - Street 2:SUITE 1A PMB 268
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106-3647
Mailing Address - Country:US
Mailing Address - Phone:207-699-8674
Mailing Address - Fax:
Practice Address - Street 1:52 CENTER ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04101-3902
Practice Address - Country:US
Practice Address - Phone:207-699-8674
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-29
Last Update Date:2022-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty