Provider Demographics
NPI:1043443088
Name:RIAZ, SHEYLA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:SHEYLA
Middle Name:
Last Name:RIAZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:SHEYLA
Other - Middle Name:
Other - Last Name:MEJIAS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LSW
Mailing Address - Street 1:58 FREEMAN STREET
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07105-4005
Mailing Address - Country:US
Mailing Address - Phone:973-639-6629
Mailing Address - Fax:
Practice Address - Street 1:58 FREEMAN ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07105-4005
Practice Address - Country:US
Practice Address - Phone:973-639-6629
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-25
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL055649001041C0700X
NJ44SC054914001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ0897345Medicaid