Healthcare Provider Details

I. General information

NPI: 1164770681
Provider Name (Legal Business Name): SHAYNE T GELBFISH-FREUND LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2012
Last Update Date: 08/15/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 14TH ST
LAKEWOOD NJ
08701-1916
US

IV. Provider business mailing address

15 14TH ST
LAKEWOOD NJ
08701-1916
US

V. Phone/Fax

Practice location:
  • Phone: 732-367-9206
  • Fax:
Mailing address:
  • Phone: 732-367-9206
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC05393300
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: