Provider Demographics
NPI:1033280169
Name:SHAGAWAT, LUBA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LUBA
Middle Name:
Last Name:SHAGAWAT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:642 PINES LAKE DR E
Mailing Address - Street 2:
Mailing Address - City:WAYNE
Mailing Address - State:NJ
Mailing Address - Zip Code:07470-6268
Mailing Address - Country:US
Mailing Address - Phone:973-831-1710
Mailing Address - Fax:973-831-1710
Practice Address - Street 1:642 PINES LAKE DR E
Practice Address - Street 2:
Practice Address - City:WAYNE
Practice Address - State:NJ
Practice Address - Zip Code:07470-6268
Practice Address - Country:US
Practice Address - Phone:973-831-1710
Practice Address - Fax:973-831-1710
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC014354001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical