Provider Demographics
NPI:1386771244
Name:SOMAL, SHELOMOH JAMES THOMAS JR (MSW)
Entity type:Individual
Prefix:MR
First Name:SHELOMOH
Middle Name:JAMES THOMAS
Last Name:SOMAL
Suffix:JR
Gender:M
Credentials:MSW
Other - Prefix:MR
Other - First Name:SHELOMOH
Other - Middle Name:ACHMED
Other - Last Name:SOMAL
Other - Suffix:JR
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:120 SE MANLY AVE
Mailing Address - Street 2:
Mailing Address - City:PORT SAINT LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34983
Mailing Address - Country:US
Mailing Address - Phone:786-351-5192
Mailing Address - Fax:
Practice Address - Street 1:120 SE MANLY AVE
Practice Address - Street 2:
Practice Address - City:PORT SAINT LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34983
Practice Address - Country:US
Practice Address - Phone:786-351-5192
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-27
Last Update Date:2019-03-25
Deactivation Date:2007-07-17
Deactivation Code:
Reactivation Date:2019-03-25
Provider Licenses
StateLicense IDTaxonomies
FL104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker