Provider Demographics
NPI:1538215587
Name:SHURLAN, ROBERTA LU G (LICSW)
Entity type:Individual
Prefix:
First Name:ROBERTA LU
Middle Name:G
Last Name:SHURLAN
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:LU
Other - Middle Name:G
Other - Last Name:SHURLAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:11 BROOKWOOD RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02420-2107
Mailing Address - Country:US
Mailing Address - Phone:781-744-8786
Mailing Address - Fax:
Practice Address - Street 1:11 BROOKWOOD RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02420-2107
Practice Address - Country:US
Practice Address - Phone:781-744-8786
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1029831041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical