Provider Demographics
NPI:1558894501
Name:STAFFORD, RESHMA (PSYD)
Entity Type:Individual
Prefix:
First Name:RESHMA
Middle Name:
Last Name:STAFFORD
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16 NEWPORT DR
Mailing Address - Street 2:
Mailing Address - City:PRINCETON JUNCTION
Mailing Address - State:NJ
Mailing Address - Zip Code:08550-2224
Mailing Address - Country:US
Mailing Address - Phone:732-841-9334
Mailing Address - Fax:
Practice Address - Street 1:20 NASSAU ST STE 511
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08542-4505
Practice Address - Country:US
Practice Address - Phone:732-440-8011
Practice Address - Fax:732-527-3099
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-06
Last Update Date:2018-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35S100589100103T00000X, 103TC0700X
PAPS018256103TF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TF0000XBehavioral Health & Social Service ProvidersPsychologistFamily