Provider Demographics
NPI:1902953151
Name:SOLOMON, SHELLEY J (LCSW)
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:J
Last Name:SOLOMON
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12886 N EAGLEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:ORO VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85755-1766
Mailing Address - Country:US
Mailing Address - Phone:520-400-0924
Mailing Address - Fax:520-742-2243
Practice Address - Street 1:12470 N RANCHO VISTOSO BLVD
Practice Address - Street 2:SUITE 150
Practice Address - City:ORO VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85755-1878
Practice Address - Country:US
Practice Address - Phone:520-400-0924
Practice Address - Fax:520-742-2243
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ120321041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZLCSW 12032OtherSTATE LICENSE