Provider Demographics
NPI:1255667937
Name:SHULKIN, SONYA LEE (LCSW)
Entity Type:Individual
Prefix:
First Name:SONYA
Middle Name:LEE
Last Name:SHULKIN
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 1:105 MARYWATERSFORD RD
Mailing Address - Street 2:
Mailing Address - City:BALA CYNWYD
Mailing Address - State:PA
Mailing Address - Zip Code:19004-2020
Mailing Address - Country:US
Mailing Address - Phone:610-667-7645
Mailing Address - Fax:
Practice Address - Street 1:105 MARYWATERSFORD RD
Practice Address - Street 2:
Practice Address - City:BALA CYNWYD
Practice Address - State:PA
Practice Address - Zip Code:19004-2020
Practice Address - Country:US
Practice Address - Phone:610-667-7645
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-10-30
Last Update Date:2009-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW 001461-E101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health