Provider Demographics
NPI:1104068642
Name:JOSEPH, SHELLEY ROBERTSON (PSYD)
Entity type:Individual
Prefix:DR
First Name:SHELLEY
Middle Name:ROBERTSON
Last Name:JOSEPH
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25 W FERRY RD
Mailing Address - Street 2:
Mailing Address - City:YARDLEY
Mailing Address - State:PA
Mailing Address - Zip Code:19067-7435
Mailing Address - Country:US
Mailing Address - Phone:215-704-1278
Mailing Address - Fax:
Practice Address - Street 1:110 S STATE ST
Practice Address - Street 2:
Practice Address - City:NEWTOWN
Practice Address - State:PA
Practice Address - Zip Code:18940-3508
Practice Address - Country:US
Practice Address - Phone:215-704-1278
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-30
Last Update Date:2009-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS016608103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist