Provider Demographics
NPI:1063374023
Name:SHIVELY, CECELIA CHRISTY (MS, LBS)
Entity type:Individual
Prefix:
First Name:CECELIA
Middle Name:CHRISTY
Last Name:SHIVELY
Suffix:
Gender:F
Credentials:MS, LBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1109 PEDERSON BLVD
Mailing Address - Street 2:
Mailing Address - City:ATCO
Mailing Address - State:NJ
Mailing Address - Zip Code:08004-1454
Mailing Address - Country:US
Mailing Address - Phone:856-905-4147
Mailing Address - Fax:
Practice Address - Street 1:17 W RED BANK AVE STE 103
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:NJ
Practice Address - Zip Code:08096-1630
Practice Address - Country:US
Practice Address - Phone:856-480-0688
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-11-28
Last Update Date:2025-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst