Provider Demographics
NPI:1083349864
Name:TOSE, SHANIEK (LCSW)
Entity Type:Individual
Prefix:
First Name:SHANIEK
Middle Name:
Last Name:TOSE
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:PSC 305 BOX 1007
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96218-0011
Mailing Address - Country:US
Mailing Address - Phone:978-238-9499
Mailing Address - Fax:
Practice Address - Street 1:BLDG 180
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96218
Practice Address - Country:US
Practice Address - Phone:978-238-9499
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-18
Last Update Date:2022-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HILCSW-48371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
HILCSW-4837OtherLCSW