Provider Demographics
NPI:1528536851
Name:SHAKOW, RIVKA (LSW)
Entity Type:Individual
Prefix:
First Name:RIVKA
Middle Name:
Last Name:SHAKOW
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1301 SPRINGDALE RD STE 150
Mailing Address - Street 2:
Mailing Address - City:CHERRY HILL
Mailing Address - State:NJ
Mailing Address - Zip Code:08003-2763
Mailing Address - Country:US
Mailing Address - Phone:856-424-1333
Mailing Address - Fax:
Practice Address - Street 1:1301 SPRINGDALE RD STE 150
Practice Address - Street 2:
Practice Address - City:CHERRY HILL
Practice Address - State:NJ
Practice Address - Zip Code:08003-2763
Practice Address - Country:US
Practice Address - Phone:856-424-1333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-05
Last Update Date:2018-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW129900104100000X
NJ44SL05986300104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker