Provider Demographics
NPI:1962507434
Name:SHAH, FAUZIA F (LCSW)
Entity Type:Individual
Prefix:MS
First Name:FAUZIA
Middle Name:F
Last Name:SHAH
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 1:10411 CHANDLER WAY
Mailing Address - Street 2:
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27614-6544
Mailing Address - Country:US
Mailing Address - Phone:919-961-0692
Mailing Address - Fax:919-872-9975
Practice Address - Street 1:10411 CHANDLER WAY
Practice Address - Street 2:
Practice Address - City:RALEIGH
Practice Address - State:NC
Practice Address - Zip Code:27614-6544
Practice Address - Country:US
Practice Address - Phone:919-961-0692
Practice Address - Fax:919-872-9975
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2013-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCC0009091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC137TYOtherBCBS
NC328135OtherMHN
NC7888369OtherAETNA
NCE0819OtherMEDCOST
NC6005799Medicaid
NC474902000OtherMAGELLAN
NC6002780Medicaid
NC2146137OtherCIGNA
NC492412OtherVALUE OPTIONS
NC474902000OtherMAGELLAN
NC6002780Medicaid
NC$$$$$$$$$OtherUBH
NC7888369OtherAETNA