Provider Demographics
NPI:1619008893
Name:BRESNICK, SHELLEY E (PSYD)
Entity type:Individual
Prefix:DR
First Name:SHELLEY
Middle Name:E
Last Name:BRESNICK
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1746 COLE BLVD
Mailing Address - Street 2:BLDG. 21, SUITE 295
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80401-3208
Mailing Address - Country:US
Mailing Address - Phone:303-988-8177
Mailing Address - Fax:303-988-8178
Practice Address - Street 1:1746 COLE BLVD
Practice Address - Street 2:BLDG. 21, SUITE 295
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80401-3208
Practice Address - Country:US
Practice Address - Phone:303-988-8177
Practice Address - Fax:303-988-8178
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2115103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical