Provider Demographics
NPI:1568681476
Name:SHUGRUE, MICHAEL DALTON (LCSW)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:DALTON
Last Name:SHUGRUE
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 1:24 W END AVE
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:NJ
Mailing Address - Zip Code:07940-1318
Mailing Address - Country:US
Mailing Address - Phone:908-531-1813
Mailing Address - Fax:
Practice Address - Street 1:210 MALAPARDIS RD
Practice Address - Street 2:
Practice Address - City:CEDAR KNOLLS
Practice Address - State:NJ
Practice Address - Zip Code:07927-1109
Practice Address - Country:US
Practice Address - Phone:973-605-5000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC052079001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical