Provider Demographics
NPI:1821394784
Name:CARR, SHOSHANA NIKOL (LMSW-IPR)
Entity Type:Individual
Prefix:MS
First Name:SHOSHANA
Middle Name:NIKOL
Last Name:CARR
Suffix:
Gender:F
Credentials:LMSW-IPR
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1029 JOHNSON CITY AVE
Mailing Address - Street 2:
Mailing Address - City:FORNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75126-5077
Mailing Address - Country:US
Mailing Address - Phone:214-207-9117
Mailing Address - Fax:972-552-5232
Practice Address - Street 1:1029 JOHNSON CITY AVE
Practice Address - Street 2:
Practice Address - City:FORNEY
Practice Address - State:TX
Practice Address - Zip Code:75126-5077
Practice Address - Country:US
Practice Address - Phone:214-207-9117
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-09
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171W00000X
TX38558104100000X
TX305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service
No171W00000XOther Service ProvidersContractor
No104100000XBehavioral Health & Social Service ProvidersSocial Worker