Provider Demographics
NPI:1053641050
Name:LAURA SHWAHLA
Entity Type:Organization
Organization Name:LAURA SHWAHLA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MISS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHWAHLA
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:609-510-8848
Mailing Address - Street 1:12 ROSZEL RD STE C202
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08540-6250
Mailing Address - Country:US
Mailing Address - Phone:609-510-8848
Mailing Address - Fax:
Practice Address - Street 1:12 ROSZEL RD STE C202
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:NJ
Practice Address - Zip Code:08540
Practice Address - Country:US
Practice Address - Phone:609-510-8848
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-13
Last Update Date:2019-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC05297400251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health