Provider Demographics
NPI:1790707560
Name:SHULMAN, TAMARA (PHD)
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:
Last Name:SHULMAN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:925 CLIFTON AVENUE
Mailing Address - Street 2:SUITE #103
Mailing Address - City:CLIFTON
Mailing Address - State:NJ
Mailing Address - Zip Code:07013
Mailing Address - Country:US
Mailing Address - Phone:973-471-9506
Mailing Address - Fax:212-980-0578
Practice Address - Street 1:925 CLIFTON AVENUE
Practice Address - Street 2:SUITE #103
Practice Address - City:CLIFTON
Practice Address - State:NJ
Practice Address - Zip Code:07013
Practice Address - Country:US
Practice Address - Phone:973-471-9506
Practice Address - Fax:212-980-0578
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35S100133200103T00000X
NY0064441103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJSH478016Medicare ID - Type Unspecified