Healthcare Provider Details

I. General information

NPI: 1699788596
Provider Name (Legal Business Name): SUSAN EVELYN SHAFRAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2006
Last Update Date: 09/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1371 S OCEAN BLVD
POMPANO BEACH FL
33062-7130
US

IV. Provider business mailing address

5851 HOLMBERG RD APT 2013
PARKLAND FL
33067-4536
US

V. Phone/Fax

Practice location:
  • Phone: 954-943-1155
  • Fax:
Mailing address:
  • Phone: 718-314-5450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number073494
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number078572
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSW10445
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: