Provider Demographics
NPI:1285647651
Name:SLOAN, SHIRLEY (LCSW)
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:
Last Name:SLOAN
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:PO BOX 487
Mailing Address - Street 2:
Mailing Address - City:IMMOKALEE
Mailing Address - State:FL
Mailing Address - Zip Code:34143-0487
Mailing Address - Country:US
Mailing Address - Phone:239-281-8903
Mailing Address - Fax:239-657-2308
Practice Address - Street 1:25 HOMESTEAD RD
Practice Address - Street 2:#55
Practice Address - City:LEHIGH ACRES
Practice Address - State:FL
Practice Address - Zip Code:33936-6049
Practice Address - Country:US
Practice Address - Phone:239-281-8903
Practice Address - Fax:239-657-2308
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-15
Last Update Date:2010-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW77931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ118COtherBLUECROSS BLUESHIELD OF FLORIDA