Provider Demographics
NPI:1053344747
Name:SHRENSEL, SHARON RUTH (PSYD)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:RUTH
Last Name:SHRENSEL
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 1:467 SPRINGFIELD AVE
Mailing Address - Street 2:
Mailing Address - City:SUMMIT
Mailing Address - State:NJ
Mailing Address - Zip Code:07901
Mailing Address - Country:US
Mailing Address - Phone:908-273-3971
Mailing Address - Fax:908-273-5627
Practice Address - Street 1:467 SPRINGFIELD AVE
Practice Address - Street 2:
Practice Address - City:SUMMIT
Practice Address - State:NJ
Practice Address - Zip Code:07901
Practice Address - Country:US
Practice Address - Phone:908-273-3971
Practice Address - Fax:908-273-3971
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-08
Last Update Date:2012-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1421103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SH668352Medicare ID - Type Unspecified