Provider Demographics
NPI:1164896684
Name:SHANMUGAM, UMANATHAN (MSW, LBS)
Entity Type:Individual
Prefix:
First Name:UMANATHAN
Middle Name:
Last Name:SHANMUGAM
Suffix:
Gender:M
Credentials:MSW, LBS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 WELLINGTON RD
Mailing Address - Street 2:APT 1
Mailing Address - City:UPPER DARBY
Mailing Address - State:PA
Mailing Address - Zip Code:19082-2443
Mailing Address - Country:US
Mailing Address - Phone:267-809-3978
Mailing Address - Fax:
Practice Address - Street 1:9 WELLINGTON RD
Practice Address - Street 2:APT 1
Practice Address - City:UPPER DARBY
Practice Address - State:PA
Practice Address - Zip Code:19082-2443
Practice Address - Country:US
Practice Address - Phone:267-809-3978
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-20
Last Update Date:2015-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PABH002914101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health