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General NPI Number Information
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NPI Number | 1144739012
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Entity Type | Individual
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Provider Name | BONI SHEVELOVE LSW
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Gender | Female
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Dates
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Enumeration Date | 09/23/2017
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Last Update Date | 10/12/2017
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Provider Practice Location Address
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Address Line | 129 VALLEY RD FL 2
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City | MONTCLAIR
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State | NJ
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Zip | 07042-2331
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Country | US
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Telephone | 186-248-5049
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Fax | 862-485-0493
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Provider Business Mailing Address
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Address Line | 41 HILLCREST RD
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City | WEST CALDWELL
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State | NJ
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Zip | 07006-7739
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Country | US
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Telephone | 18624850493
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 44SC05752600
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License Number State | NJ
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