Provider Demographics
NPI:1720189913
Name:BOREN, SHEDRICK JOHN (LCSW)
Entity Type:Individual
Prefix:MR
First Name:SHEDRICK
Middle Name:JOHN
Last Name:BOREN
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 1:2143 FISHER ISLAND DR
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33109-0059
Mailing Address - Country:US
Mailing Address - Phone:305-860-5246
Mailing Address - Fax:305-285-5042
Practice Address - Street 1:2143 FISHER ISLAND DR
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33109-0059
Practice Address - Country:US
Practice Address - Phone:305-860-5246
Practice Address - Fax:305-285-5042
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW53591041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical