Provider Demographics
NPI:1891264834
Name:BEGOLLY, SHAE
Entity Type:Individual
Prefix:
First Name:SHAE
Middle Name:
Last Name:BEGOLLY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 EAST AVE UNIT A
Mailing Address - Street 2:
Mailing Address - City:WOODSTOWN
Mailing Address - State:NJ
Mailing Address - Zip Code:08098-1408
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:21 EAST AVE UNIT A
Practice Address - Street 2:
Practice Address - City:WOODSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:08098-1408
Practice Address - Country:US
Practice Address - Phone:856-334-0297
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-11-20
Last Update Date:2018-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC057123001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical