Provider Demographics
NPI:1841830825
Name:MITTAL, SHEFALI (LCSW)
Entity type:Individual
Prefix:
First Name:SHEFALI
Middle Name:
Last Name:MITTAL
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 1:3590 MANOR RD
Mailing Address - Street 2:
Mailing Address - City:BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:18020-8605
Mailing Address - Country:US
Mailing Address - Phone:610-762-0475
Mailing Address - Fax:
Practice Address - Street 1:3590 MANOR RD
Practice Address - Street 2:
Practice Address - City:BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:18020-8605
Practice Address - Country:US
Practice Address - Phone:610-762-0475
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-08
Last Update Date:2020-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ44SC058914001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical