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General NPI Number Information
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NPI Number | 1558894501
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Entity Type | Individual
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Provider Name | RESHMA STAFFORD PSYD
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Gender | Female
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Dates
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Enumeration Date | 04/06/2017
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Last Update Date | 11/02/2018
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Provider Practice Location Address
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Address Line | 20 NASSAU ST STE 511
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City | PRINCETON
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State | NJ
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Zip | 08542-4505
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Country | US
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Telephone | 732-440-8011
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Fax | 732-527-3099
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Provider Business Mailing Address
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Address Line | 16 NEWPORT DR
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City | PRINCETON JUNCTION
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State | NJ
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Zip | 08550-2224
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Country | US
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Telephone | 732-841-9334
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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 | 35S100589100
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 103TF0000X
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Taxonomy Name | Family Psychologist
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License Number | PS018256
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License Number State | PA
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Taxonomy #3
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 35S100589100
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License Number State | NJ
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