Healthcare Provider Details

I. General information

NPI: 1609141456
Provider Name (Legal Business Name): SHOSHANA MAEL LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHOSHANA STORCH

II. Dates (important events)

Enumeration Date: 03/13/2012
Last Update Date: 10/08/2025
Certification Date: 10/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3458 NEELY RD
JB MDL NJ
08641-5312
US

IV. Provider business mailing address

3458 NEELY RD
JB MDL NJ
08641-5312
US

V. Phone/Fax

Practice location:
  • Phone: 609-754-9324
  • Fax:
Mailing address:
  • Phone: 609-754-9324
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number14968
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberCW017985
License Number StatePA
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC05768800
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: