Provider Demographics
NPI:1427636448
Name:ADLER, SHALOM (MSCC)
Entity type:Individual
Prefix:
First Name:SHALOM
Middle Name:
Last Name:ADLER
Suffix:
Gender:M
Credentials:MSCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1761 W HILLSBORO BLVD STE 402
Mailing Address - Street 2:
Mailing Address - City:DEERFIELD BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33442-1563
Mailing Address - Country:US
Mailing Address - Phone:954-242-8047
Mailing Address - Fax:
Practice Address - Street 1:1761 W HILLSBORO BLVD STE 402
Practice Address - Street 2:
Practice Address - City:DEERFIELD BEACH
Practice Address - State:FL
Practice Address - Zip Code:33442-1563
Practice Address - Country:US
Practice Address - Phone:954-242-8047
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-31
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL20503101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health