| Tatyana Shields, Lcsw | |
|
2412 Vetter Dr Franklin Park NJ 08823-2603 | |
| (732) 305-0335 | |
| Not Available |
| Full Name | Tatyana Shields, Lcsw |
|---|---|
| Speciality | Social Worker |
| Location | 2412 Vetter Dr, Franklin Park, New Jersey |
| Authorized Official Name and Position | Tatyana O Shields (CEO) |
| Authorized Official Contact | 9083310665 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Tatyana Shields, Lcsw 3495 Us Highway 1 Ste 34 #1140 Princeton NJ 08540 Ph: (732) 305-0335 | Tatyana Shields, Lcsw 2412 Vetter Dr Franklin Park NJ 08823-2603 Ph: (732) 305-0335 |
| NPI Number | 1750015160 |
|---|---|
| Provider Enumeration Date | 07/12/2022 |
| Last Update Date | 08/07/2023 |
| Certification Date | 08/02/2023 |
| Medicare PECOS PAC ID | 3375924368 |
|---|---|
| Medicare Enrollment ID | O20220722000021 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1750015160 | NPI | - | NPPES |
| 44SC05995800 | Other | NJ | NJ PROFESSIONAL LICENSE |
| 092056 | Other | NY | NYS PROFESSIONAL LICENSE |
| CW022019 | Other | PA | PA PROFESSIONAL LICENSE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Tatyana O Shields |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1255877429 PECOS PAC ID: 8628460888 Enrollment ID: I20220120000007 |
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