Provider Demographics
NPI:1366729691
Name:PRICHARD, SHAWN T (PHD)
Entity type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:T
Last Name:PRICHARD
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 1:23 PARKWAY
Mailing Address - Street 2:
Mailing Address - City:KATONAH
Mailing Address - State:NY
Mailing Address - Zip Code:10536-1570
Mailing Address - Country:US
Mailing Address - Phone:347-672-7197
Mailing Address - Fax:
Practice Address - Street 1:23 PARKWAY
Practice Address - Street 2:
Practice Address - City:KATONAH
Practice Address - State:NY
Practice Address - Zip Code:10536-1570
Practice Address - Country:US
Practice Address - Phone:347-672-7197
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-15
Last Update Date:2011-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY015395-1103T00000X
CT002455103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist