Active NPI
Susan Shipley, PHD
- Clinical Psychologist
- Philadelphia, PA
National Provider Identifier
1790112803
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- PS017443
- Practice address
- 265 E Lehigh Ave
Philadelphia, PA 19125-1013 - Phone
- (215) 203-5400
- Fax
- (215) 291-5149
- NPI assigned
- Oct 3, 2013
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | PC003368 | PA | |
| Clinical Psychologist | 103TC0700X | PS017443 | PA | Primary |
Addresses
Primary practice location
265 E Lehigh Ave
Philadelphia, PA 19125-1013
Mailing address
265 E Lehigh Ave
Philadelphia, PA 19125-1013
Phone (215) 203-5400
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PC003368 | PA | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1380758400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1380758400000",
"number": "1790112803",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "265 E LEHIGH AVE",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191251013",
"telephone_number": "215-203-5400",
"fax_number": "215-291-5149"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "265 E LEHIGH AVE",
"city": "PHILADELPHIA",
"state": "PA",
"postal_code": "191251013",
"telephone_number": "215-203-5400",
"fax_number": "215-291-5149"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHIPLEY",
"first_name": "SUSAN",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2013-10-03",
"last_updated": "2013-10-03",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "PA",
"license": "PC003368",
"primary": false
},
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "PA",
"license": "PS017443",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Philadelphia, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.