Provider Demographics
NPI:1346551355
Name:SHAULSON, MALKY (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:MALKY
Middle Name:
Last Name:SHAULSON
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 1:58 ENCLAVE BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:NJ
Mailing Address - Zip Code:08701-5783
Mailing Address - Country:US
Mailing Address - Phone:718-757-9290
Mailing Address - Fax:
Practice Address - Street 1:58 ENCLAVE BLVD
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-5783
Practice Address - Country:US
Practice Address - Phone:718-757-9290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-24
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY070738-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical