Shadybrook Psychological Services PLLC

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

Legal business name

SHADYBROOK PSYCHOLOGICAL SERVICES PLLC

Practice address

2554 Lewisville Clemmons Rd Ste 304
Clemmons, NC 27012-8749

Phone

(636) 487-7654

NPI assigned

Jan 3, 2022

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Susanne Palmer, PHD

Title

Owner/Authorized Official

Phone

(336) 200-8808

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1641168000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1718582400000",
    "number": "1225799257",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2554 LEWISVILLE CLEMMONS RD STE 304",
            "city": "CLEMMONS",
            "state": "NC",
            "postal_code": "270128749"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2554 LEWISVILLE CLEMMONS RD STE 304",
            "city": "CLEMMONS",
            "state": "NC",
            "postal_code": "270128749",
            "telephone_number": "636-487-7654"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SHADYBROOK PSYCHOLOGICAL SERVICES PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-01-03",
        "last_updated": "2024-06-17",
        "certification_date": "2024-06-17",
        "status": "A",
        "authorized_official_last_name": "PALMER",
        "authorized_official_first_name": "SUSANNE",
        "authorized_official_title_or_position": "OWNER/AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "336-200-8808",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Psychologist, Clinical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Emily Schmutz, PA-C
• Billie Thompson Schneider, RPH
• Ashley Michele Schofield, DMD
• Emily Kathryn Seal, MD
• Justin Fletcher Segrest, FNP, MSN, RN
• Amelia Rhoades Shepherd, OTR/L
• Kelsey Shook
• Madison Shreve, LCMHCA
• Candice Simpson
• Rebecca Adams Sluder, M.A., CCC-SLP

• Clinical Psychologist in Clemmons, NC
• Providers in Clemmons, NC by specialty
• Clinical Psychologist in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 17, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.