Provider Demographics
NPI:1093410474
Name:SHUKLA, DEEPA S (LMSW)
Entity Type:Individual
Prefix:
First Name:DEEPA
Middle Name:S
Last Name:SHUKLA
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 W MONTGOMERY AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-4216
Mailing Address - Country:US
Mailing Address - Phone:240-686-5390
Mailing Address - Fax:
Practice Address - Street 1:50 W MONTGOMERY AVE
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-4216
Practice Address - Country:US
Practice Address - Phone:240-686-5390
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-04
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program