Provider Demographics
NPI:1598945149
Name:SHALLCROSS, HARRY MICHAEL (PHD)
Entity Type:Individual
Prefix:DR
First Name:HARRY
Middle Name:MICHAEL
Last Name:SHALLCROSS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 TEE PEE CT
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:NJ
Mailing Address - Zip Code:08055-9763
Mailing Address - Country:US
Mailing Address - Phone:609-654-5977
Mailing Address - Fax:
Practice Address - Street 1:41 TEE PEE CT
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:NJ
Practice Address - Zip Code:08055-9763
Practice Address - Country:US
Practice Address - Phone:609-654-5977
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-13
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35S100180500103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist