Provider Demographics
NPI:1861411878
Name:CONTRES, SHEREE A (PSYD)
Entity type:Individual
Prefix:
First Name:SHEREE
Middle Name:A
Last Name:CONTRES
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 1:175 LANCASTER BLVD
Mailing Address - Street 2:P O BOX 2028
Mailing Address - City:MECHANICSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17055-3562
Mailing Address - Country:US
Mailing Address - Phone:717-691-3755
Mailing Address - Fax:717-790-8505
Practice Address - Street 1:175 LANCASTER BLVD
Practice Address - Street 2:
Practice Address - City:MECHANICSBURG
Practice Address - State:PA
Practice Address - Zip Code:17055-3562
Practice Address - Country:US
Practice Address - Phone:717-691-3755
Practice Address - Fax:717-790-8505
Is Sole Proprietor?:No
Enumeration Date:2006-07-19
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS007104L103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAQ35597Medicare UPIN
PA857311KCUMedicare PIN