Provider Demographics
NPI:1982372256
Name:SHAGALOW, NECHAMA LAYAH (LICSW)
Entity Type:Individual
Prefix:
First Name:NECHAMA
Middle Name:LAYAH
Last Name:SHAGALOW
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2834 RALEIGH AVE
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55416-1967
Mailing Address - Country:US
Mailing Address - Phone:612-205-5293
Mailing Address - Fax:
Practice Address - Street 1:2834 RALEIGH AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55416-1967
Practice Address - Country:US
Practice Address - Phone:612-205-5293
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-01
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN255981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical