Healthcare Provider Details

I. General information

NPI: 1801771704
Provider Name (Legal Business Name): SHAKIA WYCHE MSW, LSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/08/2025
Last Update Date: 09/14/2026
Certification Date: 09/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

150 BERGEN ST
NEWARK NJ
07103-2496
US

IV. Provider business mailing address

267 CHESTNUT ST
PASSAIC NJ
07055-4247
US

V. Phone/Fax

Practice location:
  • Phone: 973-972-4300
  • Fax:
Mailing address:
  • Phone: 973-979-9869
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number44SC06690400
License Number StateNJ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: