Provider Demographics
NPI:1972954378
Name:SHUTY, SANDRA E (LCSW)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:E
Last Name:SHUTY
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 1:180 CYPRESS CLUB DR
Mailing Address - Street 2:APT 805
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33060-4773
Mailing Address - Country:US
Mailing Address - Phone:724-799-1761
Mailing Address - Fax:
Practice Address - Street 1:180 CYPRESS CLUB DR
Practice Address - Street 2:APT 805
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33060-4773
Practice Address - Country:US
Practice Address - Phone:724-799-1761
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-27
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW128631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical