Healthcare Provider Details

I. General information

NPI: 1619156122
Provider Name (Legal Business Name): SHANA MALTZMAN LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: SHANA DUBIN CSW

II. Dates (important events)

Enumeration Date: 10/31/2007
Last Update Date: 12/18/2025
Certification Date: 12/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

66 CARRIAGE LN
ENGLISHTOWN NJ
07726-1641
US

IV. Provider business mailing address

66 CARRIAGE LN
ENGLISHTOWN NJ
07726-1641
US

V. Phone/Fax

Practice location:
  • Phone: 732-804-2352
  • Fax:
Mailing address:
  • Phone: 917-583-6537
  • Fax: 718-749-0110

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC06481300
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: