Organization
ELITE EDUCATIONAL AND THERAPEUTIC SUPPORT SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. RICHARD A SHILLABEER PSY.D. (CEO)
(570) 466-5870
Entity
Organization
Contact information
Practice address
17946 CONTADOR DR, ROWLAND HEIGHTS, CA 91748-4328
(570) 466-5870
Mailing address
155 COLUMBIA ST, DURYEA, PA 18642-1403
(570) 466-5870
Taxonomy
Speciality
Code
Description
License number
State
103TS0200X
School Psychologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
LEP3615
EDUCATIONAL PSYCHOLOGY
CA
Enumeration date
01/12/2021
Last updated
01/12/2021
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