Provider Demographics
NPI:1871345181
Name:BLADES, SHANITA (LMSW)
Entity type:Individual
Prefix:
First Name:SHANITA
Middle Name:
Last Name:BLADES
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1214 BOWER ST
Mailing Address - Street 2:
Mailing Address - City:LINDEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07036-2547
Mailing Address - Country:US
Mailing Address - Phone:347-645-5568
Mailing Address - Fax:
Practice Address - Street 1:1214 BOWER ST
Practice Address - Street 2:
Practice Address - City:LINDEN
Practice Address - State:NJ
Practice Address - Zip Code:07036-2547
Practice Address - Country:US
Practice Address - Phone:347-645-5568
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-02
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY117432104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker