Organization
ANDREA SHELLEY, CLINICAL & FORENSIC PSYCHOLOGY, A PROFESSIONAL CORPORA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ANDREA SHELLEY PSY.D. (PRESIDENT)
(415) 515-3211
Entity
Organization
Contact information
Practice address
1832 CENTRO WEST ST, TIBURON, CA 94920-1909
(415) 515-3211
Mailing address
1832 CENTRO WEST ST, TIBURON, CA 94920-1909
(415) 515-3211
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PSY20375
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
113038
MEDICARE PART B
CA
01
—
HD866A
MEDICARE PART B
CA
Enumeration date
01/21/2015
Last updated
01/21/2015
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