=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104276526
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | WEE GROW LCSW PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/16/2016
-----------------------------------------------------
Last Update Date | 06/16/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 203 CUMLEY TER
-----------------------------------------------------
City | LEONIA
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07605-1112
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-887-8906
-----------------------------------------------------
Fax | 201-346-1698
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 203 CUMLEY TER
-----------------------------------------------------
City | LEONIA
-----------------------------------------------------
State | NJ
-----------------------------------------------------
Zip | 07605-1112
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 917-887-8906
-----------------------------------------------------
Fax | 201-346-1698
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | SOCIAL WORKER
-----------------------------------------------------
Name | MS. SYLVIA SHAIK
-----------------------------------------------------
Credential | MSW LCSW
-----------------------------------------------------
Telephone | 917-887-8906
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251K00000X
-----------------------------------------------------
Taxonomy Name | Public Health or Welfare Agency
-----------------------------------------------------
License Number | R0321021
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------