Provider Demographics
NPI:1740821040
Name:REEVES, SHAN LAMONT (LCSW)
Entity type:Individual
Prefix:
First Name:SHAN
Middle Name:LAMONT
Last Name:REEVES
Suffix:
Gender:M
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:D21 AVON DR W
Mailing Address - Street 2:
Mailing Address - City:EAST WINDSOR
Mailing Address - State:NJ
Mailing Address - Zip Code:08520-5545
Mailing Address - Country:US
Mailing Address - Phone:732-762-0922
Mailing Address - Fax:
Practice Address - Street 1:500 RT 33 WEST
Practice Address - Street 2:SIDD PLAZA, SUITE 2G
Practice Address - City:MILLSTONE
Practice Address - State:NJ
Practice Address - Zip Code:08535
Practice Address - Country:US
Practice Address - Phone:732-762-0922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-08
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC055304001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical