Provider Demographics
NPI:1386794832
Name:KANAL, SHOBHANA LAVEEN (MSS, LCSW)
Entity type:Individual
Prefix:MS
First Name:SHOBHANA
Middle Name:LAVEEN
Last Name:KANAL
Suffix:
Gender:F
Credentials:MSS, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:364 TREVOR LN
Mailing Address - Street 2:
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-2329
Mailing Address - Country:US
Mailing Address - Phone:484-716-8625
Mailing Address - Fax:
Practice Address - Street 1:355 LANCASTER AVE
Practice Address - Street 2:BLDG. C, 2ND FLOOR
Practice Address - City:HAVERFORD
Practice Address - State:PA
Practice Address - Zip Code:19041-1547
Practice Address - Country:US
Practice Address - Phone:484-716-8625
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-10
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0170341041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical