Provider Demographics
NPI:1760534614
Name:SINGH, SHELLY N (LCSW)
Entity Type:Individual
Prefix:MS
First Name:SHELLY
Middle Name:N
Last Name:SINGH
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1870 N LAWNWOOD CIR
Mailing Address - Street 2:SUITE A - E
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34950-4828
Mailing Address - Country:US
Mailing Address - Phone:772-461-0820
Mailing Address - Fax:772-461-0823
Practice Address - Street 1:1870 N LAWNWOOD CIR
Practice Address - Street 2:SUITE A - E
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34950-4828
Practice Address - Country:US
Practice Address - Phone:772-461-0820
Practice Address - Fax:772-467-0823
Is Sole Proprietor?:No
Enumeration Date:2007-01-18
Last Update Date:2013-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW92041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
BR336AOtherMEDICARE PTAN