Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103G00000X | Clinical Psychologist | 001549 | CT |
Y | 103TC0700X | Clinical Psychologist | 001549 | CT |
NPI | 1003923210 |
---|---|
Provider Name | Dr. Laura J Shackelford |
First Address | New Milford, CT 06776-5528 |
Second Address | New Milford, CT 06776-5528 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/08/2006 |
Last Update Date | 08/07/2007 |