Provider Demographics
NPI:1588281851
Name:SHELLEY, RACHEL LYNN (PHD)
Entity type:Individual
Prefix:DR
First Name:RACHEL
Middle Name:LYNN
Last Name:SHELLEY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:RACHEL
Other - Middle Name:LYNN
Other - Last Name:GOLDMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:330 W 58TH ST STE 604C
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-1817
Mailing Address - Country:US
Mailing Address - Phone:646-450-3455
Mailing Address - Fax:
Practice Address - Street 1:330 W 58TH ST STE 604C
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-1817
Practice Address - Country:US
Practice Address - Phone:646-450-3455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-02
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103T00000XBehavioral Health & Social Service ProvidersPsychologist