Provider Demographics
NPI:1437865474
Name:SHELTON, SINNAMON (LCSW)
Entity Type:Individual
Prefix:
First Name:SINNAMON
Middle Name:
Last Name:SHELTON
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 1:30 MOONACHIE RD APT 3A
Mailing Address - Street 2:
Mailing Address - City:HACKENSACK
Mailing Address - State:NJ
Mailing Address - Zip Code:07601-6533
Mailing Address - Country:US
Mailing Address - Phone:732-662-8865
Mailing Address - Fax:
Practice Address - Street 1:78 JOHN MILLER WAY
Practice Address - Street 2:
Practice Address - City:KEARNY
Practice Address - State:NJ
Practice Address - Zip Code:07032-6500
Practice Address - Country:US
Practice Address - Phone:551-275-5674
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-24
Last Update Date:2023-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC06136100101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty