Provider Demographics
NPI:1477321289
Name:TEKWANI, SHRUTI (LMHC)
Entity Type:Individual
Prefix:
First Name:SHRUTI
Middle Name:
Last Name:TEKWANI
Suffix:
Gender:F
Credentials:LMHC
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 6052
Mailing Address - Street 2:
Mailing Address - City:GLOUCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01930-4752
Mailing Address - Country:US
Mailing Address - Phone:508-648-2299
Mailing Address - Fax:
Practice Address - Street 1:#1 KAYA GUZMANBLANCU
Practice Address - Street 2:
Practice Address - City:CURACAO
Practice Address - State:CURACAO
Practice Address - Zip Code:00000
Practice Address - Country:AN
Practice Address - Phone:508-648-2299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-12
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10350101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health