Provider Demographics
NPI:1376618728
Name:SHULDER, NORMAN HOWARD (LCSW-R)
Entity Type:Individual
Prefix:MR
First Name:NORMAN
Middle Name:HOWARD
Last Name:SHULDER
Suffix:
Gender:M
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 RUSSELL LANE
Mailing Address - Street 2:
Mailing Address - City:PATCHOGUE
Mailing Address - State:NY
Mailing Address - Zip Code:11772-0446
Mailing Address - Country:US
Mailing Address - Phone:631-654-9279
Mailing Address - Fax:631-447-0511
Practice Address - Street 1:755 WAVERLY AVENUE SUITE 304
Practice Address - Street 2:
Practice Address - City:HOLTSVILLE
Practice Address - State:NY
Practice Address - Zip Code:11742
Practice Address - Country:US
Practice Address - Phone:631-447-9600
Practice Address - Fax:631-447-0511
Is Sole Proprietor?:No
Enumeration Date:2006-11-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0353541104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
N23321Medicare UPIN
NYN23321Medicare ID - Type Unspecified