Provider Demographics
NPI:1013202837
Name:SHOMAR, ATIQ MIRRIAM (LCSW)
Entity type:Individual
Prefix:
First Name:ATIQ
Middle Name:MIRRIAM
Last Name:SHOMAR
Suffix:
Gender:X
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10501 E SEVEN GENERATIONS WAY STE 121
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85747-5828
Mailing Address - Country:US
Mailing Address - Phone:520-833-4290
Mailing Address - Fax:888-972-9484
Practice Address - Street 1:10501 E SEVEN GENERATIONS WAY STE 121
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85747-5828
Practice Address - Country:US
Practice Address - Phone:520-833-4290
Practice Address - Fax:888-972-9484
Is Sole Proprietor?:No
Enumeration Date:2011-06-09
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLCSW-13586101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health