Provider Demographics
NPI:1376948083
Name:SHAPIRO, E NOACH (LCSW)
Entity Type:Individual
Prefix:
First Name:E NOACH
Middle Name:
Last Name:SHAPIRO
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 PARK ST
Mailing Address - Street 2:STE 3
Mailing Address - City:MONTCLAIR
Mailing Address - State:NJ
Mailing Address - Zip Code:07042-2963
Mailing Address - Country:US
Mailing Address - Phone:973-718-9943
Mailing Address - Fax:
Practice Address - Street 1:101 PARK ST
Practice Address - Street 2:STE 3
Practice Address - City:MONTCLAIR
Practice Address - State:NJ
Practice Address - Zip Code:07042-2963
Practice Address - Country:US
Practice Address - Phone:973-718-9943
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-24
Last Update Date:2015-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC056014001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ1679945133OtherBUSINESS NPI