Provider Demographics
NPI:1669821286
Name:SHADRIN-TOLEDO, ROSA STEPHANIE (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ROSA
Middle Name:STEPHANIE
Last Name:SHADRIN-TOLEDO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MISS
Other - First Name:ROSA
Other - Middle Name:STEPHANIE
Other - Last Name:TOLEDO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:6 RED SUNSET LN
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27703-3394
Mailing Address - Country:US
Mailing Address - Phone:919-455-4555
Mailing Address - Fax:
Practice Address - Street 1:2020 CHAPEL HILL RD STE 23
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27707-1186
Practice Address - Country:US
Practice Address - Phone:919-688-7101
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-03
Last Update Date:2019-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCP0105011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical