MEDICARE: SHOSHANA SHALOM LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	C.2507321	OH

General Provider Information

NPI Number	:	1083563241
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHOSHANA SHALOM LPC

Provider Business Mailing Address
First Line	:	3784 MONTEVISTA RD
Second Line	:
City	:	CLEVELAND HEIGHTS
State	:	OH
Zip	:	44121-1615
Country	:	US
Telephone Number	:	508-612-0972
Fax Number	:

Provider Business Practice Location Address
First Line	:	8334 TYLER BLVD
Second Line	:
City	:	MENTOR
State	:	OH
Zip	:	44060-4221
Country	:	US
Telephone Number	:	440-299-7854
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/22/2026
Last Update Date	:	01/22/2026

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Directions to “ SHOSHANA SHALOM LPC” Practice Location

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