Provider Demographics
NPI:1265041214
Name:KANAREK, SHOSHANA LEAH (LSW)
Entity Type:Individual
Prefix:
First Name:SHOSHANA
Middle Name:LEAH
Last Name:KANAREK
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 1:127 E 8TH ST
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-2020
Mailing Address - Country:US
Mailing Address - Phone:848-223-3491
Mailing Address - Fax:
Practice Address - Street 1:1483 E SPRUCE ST
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-5444
Practice Address - Country:US
Practice Address - Phone:732-276-5828
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-27
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL06551900104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker