Provider Demographics
NPI:1043567795
Name:MCSHANE, AI (LCSW)
Entity Type:Individual
Prefix:
First Name:AI
Middle Name:
Last Name:MCSHANE
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 1:2100 WESCOTT DR
Mailing Address - Street 2:HBH 5TH FL
Mailing Address - City:FLEMINGTON
Mailing Address - State:NJ
Mailing Address - Zip Code:08822
Mailing Address - Country:US
Mailing Address - Phone:908-788-6401
Mailing Address - Fax:908-237-5435
Practice Address - Street 1:190 STATE ROUTE 31
Practice Address - Street 2:STE 100
Practice Address - City:FLEMINGTON
Practice Address - State:NJ
Practice Address - Zip Code:08822-5773
Practice Address - Country:US
Practice Address - Phone:908-788-6401
Practice Address - Fax:908-237-5435
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-13
Last Update Date:2012-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC054060001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical