Organization Name: | SHORELINE PEDIATRIC NEUROPSYCHOLOGICAL SERVICES, LLC |
NPI Number: | 1992999767 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | SHELLEY FRAZIER PELLETIER (PEDIATRIC NEUROPSYCHOLOGY) |
Mailing Address: | 954 Middlesex Tpke Ste A2 Old Saybrook |
State: | CT US |
Postal Code: | 064751302 |
Phone Number: | 8603882000 |
Fax Number: | 8603882000 |
NPI Enumeration Date: | 09/05/2007 |
NPI Last Update Date: | 04/06/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 103G00000X |
License Number: | 2736 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CT |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Clinical Neuropsychologist |
Taxonomy Specialization: | |
Taxonomy Definition: | An individual with a doctorate degree, licensure in clinical psychology and specialized training or board certification in neuropsychology who practices or adheres to the principles of neuropsychology; a specialty within the field of psychology focusing primarily on neurobehavioral functioning. |