Provider Demographics
NPI:1144739012
Name:SHEVELOVE, BONI (LSW)
Entity Type:Individual
Prefix:
First Name:BONI
Middle Name:
Last Name:SHEVELOVE
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 HILLCREST RD
Mailing Address - Street 2:
Mailing Address - City:WEST CALDWELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07006-7739
Mailing Address - Country:US
Mailing Address - Phone:1862-485-0493
Mailing Address - Fax:
Practice Address - Street 1:129 VALLEY RD FL 2
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-2331
Practice Address - Country:US
Practice Address - Phone:186-248-5049
Practice Address - Fax:862-485-0493
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-23
Last Update Date:2017-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC05752600104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker