MEDICARE: DR. SHELLEY LYNNE ROSENFELD PH.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	SI 03336	NJ

General Provider Information

NPI Number	:	1902877343
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SHELLEY LYNNE ROSENFELD PH.D.

Provider Business Mailing Address
First Line	:	1810 SHORE RD
Second Line	:
City	:	NORTHFIELD
State	:	NJ
Zip	:	08225-2220
Country	:	US
Telephone Number	:	609-653-8600
Fax Number	:	609-829-5054

Provider Business Practice Location Address
First Line	:	222 NEW RD
Second Line	:	SUITE 106
City	:	LINWOOD
State	:	NJ
Zip	:	08221-1299
Country	:	US
Telephone Number	:	609-653-8600
Fax Number	:	609-653-8612

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/01/2006
Last Update Date	:	08/14/2007

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