Individual provider Active NPI

Brenda Shelley-McIntyre, PH. D.

  • Clinical Psychologist
  • Teaneck, NJ
National Provider Identifier
1699711523
Registry record updated Jul 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
35S100245700 Issued in NJ
Practice address
121 Cedar LN
Teaneck, NJ 07666-4457
Phone
(201) 628-5030
Fax
(201) 594-0144
NPI assigned
Jun 21, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 35S100245700 NJ Primary

Addresses

Primary practice location

121 Cedar LN
Teaneck, NJ 07666-4457

Mailing address

121 Cedar LN
Teaneck, NJ 07666-4457
Phone (201) 628-5030

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20161123001544 CA Practitioner - Clinical Psychologist 2567365760 Practice locations: Laguna Niguel, CA

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1986
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

30011 Ivy Glenn Dr
Laguna Niguel, CA 92677-5017
Phone (949) 505-3789

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
35S100245700NJMDClinical Psychologist
25819CAMDGeneral Practice Dentistry

Practice roles

OrganizationSpecialtyStatusNew patients
KR Psychological Services, Inc Clinical PastSince Jan 17, 2023 Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1150848000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1699711523",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "121 CEDAR LN",
            "city": "TEANECK",
            "state": "NJ",
            "postal_code": "076664457",
            "telephone_number": "201-628-5030",
            "fax_number": "201-594-0144"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "121 CEDAR LN",
            "city": "TEANECK",
            "state": "NJ",
            "postal_code": "076664457",
            "telephone_number": "201-628-5030",
            "fax_number": "201-594-0144"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHELLEY-MCINTYRE",
        "first_name": "BRENDA",
        "name_prefix": "Dr.",
        "credential": "PH. D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-06-21",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "NJ",
            "license": "35S100245700",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Teaneck, NJ

Sources for this page

Verify at the official NPI Registry.