Provider Demographics
NPI:1386371284
Name:SHURTLEFF, MEGAN (LSW)
Entity type:Individual
Prefix:
First Name:MEGAN
Middle Name:
Last Name:SHURTLEFF
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 FIELDCREST WAY
Mailing Address - Street 2:
Mailing Address - City:HAZLET
Mailing Address - State:NJ
Mailing Address - Zip Code:07730-1951
Mailing Address - Country:US
Mailing Address - Phone:607-379-0310
Mailing Address - Fax:
Practice Address - Street 1:615 HOPE RD STE 3B
Practice Address - Street 2:
Practice Address - City:EATONTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07724-1273
Practice Address - Country:US
Practice Address - Phone:732-724-1234
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-02
Last Update Date:2022-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL06695700104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker