Provider Demographics
NPI:1154146058
Name:SHELLENBERGER, CRAIG (MS)
Entity type:Individual
Prefix:
First Name:CRAIG
Middle Name:
Last Name:SHELLENBERGER
Suffix:
Gender:M
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1325 MORGAN AVE
Mailing Address - Street 2:
Mailing Address - City:CINNAMINSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08077-2729
Mailing Address - Country:US
Mailing Address - Phone:856-404-3464
Mailing Address - Fax:
Practice Address - Street 1:255 S 17TH ST STE 2121
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19103-6211
Practice Address - Country:US
Practice Address - Phone:267-225-8526
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-18
Last Update Date:2024-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health