Provider Demographics
NPI:1619721529
Name:BRABHAM, SHEKIAH (LSW)
Entity Type:Individual
Prefix:
First Name:SHEKIAH
Middle Name:
Last Name:BRABHAM
Suffix:
Gender:X
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6035 N PARK AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19141-3233
Mailing Address - Country:US
Mailing Address - Phone:267-621-9176
Mailing Address - Fax:
Practice Address - Street 1:18 CAMPUS BLVD STE 100
Practice Address - Street 2:
Practice Address - City:NEWTOWN SQUARE
Practice Address - State:PA
Practice Address - Zip Code:19073-3240
Practice Address - Country:US
Practice Address - Phone:267-995-4065
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-16
Last Update Date:2024-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA140984104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker