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General NPI Number Information
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NPI Number | 1285892372
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Entity Type | Individual
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Provider Name | SHANNON MAUREEN NICOLOFF PSY.D., L.P., RPT
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Gender | Female
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Dates
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Enumeration Date | 05/27/2008
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Last Update Date | 06/18/2014
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Provider Practice Location Address
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Address Line | 323 BUDFIELD ST
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City | JOHNSTOWN
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State | PA
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Zip | 15904-3213
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Country | US
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Telephone | 651-894-2916
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Fax |
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Provider Business Mailing Address
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Address Line | 807 SUNNEHANNA DRIVE
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City | JOHNSTOWN
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State | PA
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Zip | 15905
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Country | US
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Telephone | 651-894-2916
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number | PS017512
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License Number State | PA
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