Provider Demographics
NPI:1457617052
Name:SHAYLAND-WILLIAMS, MOISHE DAWN (MSW, LCSW)
Entity type:Individual
Prefix:
First Name:MOISHE
Middle Name:DAWN
Last Name:SHAYLAND-WILLIAMS
Suffix:
Gender:F
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:87-89 MILL STREET
Mailing Address - Street 2:
Mailing Address - City:PATERSON
Mailing Address - State:NJ
Mailing Address - Zip Code:07501
Mailing Address - Country:US
Mailing Address - Phone:973-600-3021
Mailing Address - Fax:
Practice Address - Street 1:475 PARK AVE
Practice Address - Street 2:
Practice Address - City:PATERSON
Practice Address - State:NJ
Practice Address - Zip Code:07504-1851
Practice Address - Country:US
Practice Address - Phone:973-600-3021
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-04-09
Last Update Date:2012-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC052873001041C0700X
NJ002933741041S0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool