Provider Demographics
NPI:1619669249
Name:SHALOM, CHERYL LYNN (LSW)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:LYNN
Last Name:SHALOM
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 1:28 ARLENE DR
Mailing Address - Street 2:
Mailing Address - City:WEST LONG BRANCH
Mailing Address - State:NJ
Mailing Address - Zip Code:07764-1002
Mailing Address - Country:US
Mailing Address - Phone:732-737-1166
Mailing Address - Fax:
Practice Address - Street 1:705 SUMMERFIELD AVE
Practice Address - Street 2:
Practice Address - City:ASBURY PARK
Practice Address - State:NJ
Practice Address - Zip Code:07712-6921
Practice Address - Country:US
Practice Address - Phone:732-774-6886
Practice Address - Fax:732-774-8809
Is Sole Proprietor?:No
Enumeration Date:2023-05-23
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SL06895400104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker