Provider Demographics
NPI:1881352375
Name:PRITCHETT, SHANAE (MAPD)
Entity type:Individual
Prefix:
First Name:SHANAE
Middle Name:
Last Name:PRITCHETT
Suffix:
Gender:M
Credentials:MAPD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 MOONACHIE RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07606-1640
Mailing Address - Country:US
Mailing Address - Phone:862-668-1999
Mailing Address - Fax:
Practice Address - Street 1:555 MOONACHIE RD
Practice Address - Street 2:
Practice Address - City:SOUTH HACKENSACK
Practice Address - State:NJ
Practice Address - Zip Code:07606-1640
Practice Address - Country:US
Practice Address - Phone:862-668-1999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-02
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool