Provider Demographics
NPI:1487277752
Name:SHALE PSYCHOLOGY, LLC
Entity type:Organization
Organization Name:SHALE PSYCHOLOGY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:ALLISON
Authorized Official - Middle Name:
Authorized Official - Last Name:SHALE DEUTSCH
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:201-477-8178
Mailing Address - Street 1:574 WAYNE DR
Mailing Address - Street 2:
Mailing Address - City:RIVER VALE
Mailing Address - State:NJ
Mailing Address - Zip Code:07675-6160
Mailing Address - Country:US
Mailing Address - Phone:201-370-1570
Mailing Address - Fax:
Practice Address - Street 1:82 E ALLENDALE RD STE 2B
Practice Address - Street 2:
Practice Address - City:SADDLE RIVER
Practice Address - State:NJ
Practice Address - Zip Code:07458-3057
Practice Address - Country:US
Practice Address - Phone:201-477-8178
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-05-21
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
1982956132OtherANDRUS