Provider Demographics
NPI:1326250390
Name:ANDERSON, SHALEEN DIANNA (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:SHALEEN
Middle Name:DIANNA
Last Name:ANDERSON
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 313
Mailing Address - Street 2:
Mailing Address - City:MOUNT LAUREL
Mailing Address - State:NJ
Mailing Address - Zip Code:08054-0313
Mailing Address - Country:US
Mailing Address - Phone:609-267-0899
Mailing Address - Fax:609-518-2230
Practice Address - Street 1:3121 ROUTE 38
Practice Address - Street 2:
Practice Address - City:MOUNT LAUREL
Practice Address - State:NJ
Practice Address - Zip Code:08054-9725
Practice Address - Country:US
Practice Address - Phone:609-267-0899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-04
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJSC469561041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical