Provider Demographics
NPI:1619156122
Name:MALTZMAN, SHANA (LCSW)
Entity type:Individual
Prefix:MRS
First Name:SHANA
Middle Name:
Last Name:MALTZMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:SHANA
Other - Middle Name:
Other - Last Name:DUBIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CSW
Mailing Address - Street 1:66 CARRIAGE LN
Mailing Address - Street 2:
Mailing Address - City:ENGLISHTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:07726-1641
Mailing Address - Country:US
Mailing Address - Phone:917-583-6537
Mailing Address - Fax:718-749-0110
Practice Address - Street 1:66 CARRIAGE LN
Practice Address - Street 2:
Practice Address - City:ENGLISHTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07726-1641
Practice Address - Country:US
Practice Address - Phone:732-804-2352
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-31
Last Update Date:2025-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL064919001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN4V091Medicare UPIN