Provider Demographics
NPI:1053717157
Name:SHAH, RAMESH (PHD, MSCP)
Entity type:Individual
Prefix:
First Name:RAMESH
Middle Name:
Last Name:SHAH
Suffix:
Gender:M
Credentials:PHD, MSCP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 BLOOMFIELD CT
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08810-1620
Mailing Address - Country:US
Mailing Address - Phone:732-329-2899
Mailing Address - Fax:
Practice Address - Street 1:9 BLOOMFIELD CT
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:NJ
Practice Address - Zip Code:08810-1620
Practice Address - Country:US
Practice Address - Phone:732-329-2899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-17
Last Update Date:2014-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI005119200103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist