Provider Demographics
NPI:1831323641
Name:SHULMAN, TERRENCE DARYL (LMSW)
Entity Type:Individual
Prefix:MR
First Name:TERRENCE
Middle Name:DARYL
Last Name:SHULMAN
Suffix:
Gender:M
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29748 FARMBROOK VILLA LN
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-1040
Mailing Address - Country:US
Mailing Address - Phone:248-358-8508
Mailing Address - Fax:248-358-8508
Practice Address - Street 1:29748 FARMBROOK VILLA LN
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48034-1040
Practice Address - Country:US
Practice Address - Phone:248-358-8508
Practice Address - Fax:248-358-8508
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-07
Last Update Date:2009-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010705691041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical