Healthcare Provider Details

I. General information

NPI: 1518240480
Provider Name (Legal Business Name): SHAWN PATRICK GILROY PHD NCSP BCBA-D LP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2011
Last Update Date: 07/16/2024
Certification Date: 07/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

AUDUBON 220 LOUISIANA STATE UNIVERSITY
BATON ROUGE LA
70806
US

IV. Provider business mailing address

554 WILTZ DR
BATON ROUGE LA
70806-5852
US

V. Phone/Fax

Practice location:
  • Phone: --
  • Fax:
Mailing address:
  • Phone: 201-317-4098
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number1574
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberL-384
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: