Provider Demographics
NPI:1053800029
Name:MCSHEFFREY-EMMONS, GINA MARIE
Entity type:Individual
Prefix:DR
First Name:GINA
Middle Name:MARIE
Last Name:MCSHEFFREY-EMMONS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 WESTOVER RD
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:NJ
Mailing Address - Zip Code:07044-2909
Mailing Address - Country:US
Mailing Address - Phone:718-696-8372
Mailing Address - Fax:
Practice Address - Street 1:8 HILLSIDE AVE STE 206
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-2129
Practice Address - Country:US
Practice Address - Phone:917-723-9986
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-05
Last Update Date:2018-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ173-010103TB0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral