Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 102L00000X | Psychologist | PS008666L | PA |
Y | 103T00000X | Psychologist | PS008666L | PA |
NPI | 1003872896 |
---|---|
Provider Name | Shelley Lynn Roisen |
First Address | Pittsburgh, PA 15213-3519 |
Second Address | Pittsburgh, PA 15238-3201 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/04/2006 |
Last Update Date | 07/04/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01856837 | (05) | PA |
115174 | VALUE OPTIONS (01) | PA |
201519 | UPMC HEALTH PLAN (01) | PA |
276881 | HIGHMARK BCBS (01) | PA |
P20805 | (02) |