Provider Demographics
NPI:1720825011
Name:SHAH, SHANTI (MSW, LSW)
Entity type:Individual
Prefix:
First Name:SHANTI
Middle Name:
Last Name:SHAH
Suffix:
Gender:F
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 MARIGOLD LN
Mailing Address - Street 2:
Mailing Address - City:MARLBORO
Mailing Address - State:NJ
Mailing Address - Zip Code:07746-2404
Mailing Address - Country:US
Mailing Address - Phone:732-682-9517
Mailing Address - Fax:
Practice Address - Street 1:10 MARIGOLD LN
Practice Address - Street 2:
Practice Address - City:MARLBORO
Practice Address - State:NJ
Practice Address - Zip Code:07746-2404
Practice Address - Country:US
Practice Address - Phone:732-682-9517
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-12
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL07153900104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker