Provider Demographics
NPI:1972802460
Name:SHAITELMAN, AMY MICHELE (LPC, CAGS, MS)
Entity type:Individual
Prefix:PROF
First Name:AMY
Middle Name:MICHELE
Last Name:SHAITELMAN
Suffix:
Gender:F
Credentials:LPC, CAGS, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 S HADDON AVE
Mailing Address - Street 2:
Mailing Address - City:HADDONFIELD
Mailing Address - State:NJ
Mailing Address - Zip Code:08033-1883
Mailing Address - Country:US
Mailing Address - Phone:609-929-8136
Mailing Address - Fax:
Practice Address - Street 1:15 S HADDON AVE
Practice Address - Street 2:
Practice Address - City:HADDONFIELD
Practice Address - State:NJ
Practice Address - Zip Code:08033
Practice Address - Country:US
Practice Address - Phone:609-929-8136
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-23
Last Update Date:2019-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC004751101YM0800X
NJ37PC00392800101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty