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General NPI Number Information
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NPI Number | 1932898350
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Entity Type | Individual
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Provider Name | SHANTAH NICHOLL WRIGHT LCSW
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Gender | Female
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Dates
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Enumeration Date | 05/02/2023
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Last Update Date | 02/03/2026
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Provider Practice Location Address
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Address Line | 2041 SPRINGFIELD AVE
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City | VAUXHALL
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State | NJ
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Zip | 07088-1220
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Country | US
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Telephone | 347-464-8775
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2082
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City | EAST ORANGE
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State | NJ
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Zip | 07019-2082
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Country | US
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Telephone | 347-464-8775
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 44SC06522900
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License Number State | NJ
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