Provider Demographics
NPI:1043647431
Name:SHAH, SWETA (CSW)
Entity Type:Individual
Prefix:
First Name:SWETA
Middle Name:
Last Name:SHAH
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 MT VERNON ST
Mailing Address - Street 2:APT C1
Mailing Address - City:RIDGEFIELD PARK
Mailing Address - State:NJ
Mailing Address - Zip Code:07660-1760
Mailing Address - Country:US
Mailing Address - Phone:201-401-5876
Mailing Address - Fax:
Practice Address - Street 1:101 MT VERNON ST
Practice Address - Street 2:APT C1
Practice Address - City:RIDGEFIELD PARK
Practice Address - State:NJ
Practice Address - Zip Code:07660-1760
Practice Address - Country:US
Practice Address - Phone:201-401-5876
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-01
Last Update Date:2013-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SW05280200104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker