Doctor Name: | DR. LAURA J SHACKELFORD |
NPI Number: | 1003923210 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PHD |
License Number: | 001549 |
Business Practice Address: | 219 Kent Rd Suite 14 New Milford, CT - 067765528 |
Business Phone Number: | 8603501085 |
Business Fax Number: | |
Mailing Address: | 219 Kent Rd Suite 14, NEW MILFORD |
State: | CT |
Postal Code: | 067765528 |
Phone Number: | 8603501085 |
Fax Number: | |
NPI Enumeration Date: | 08/24/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103TC0700X |
License Number: | 001549 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CT |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Psychologist |
Taxonomy Specialization: | Clinical |
Taxonomy Definition: |