Provider Demographics
NPI:1922386093
Name:SHYAM, PRINCY (MA, MSW, LCSW)
Entity type:Individual
Prefix:MRS
First Name:PRINCY
Middle Name:
Last Name:SHYAM
Suffix:
Gender:F
Credentials:MA, MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 FAIRFIELD WAY
Mailing Address - Street 2:SUITE 106
Mailing Address - City:BLOOMINGDALE
Mailing Address - State:IL
Mailing Address - Zip Code:60108-1583
Mailing Address - Country:US
Mailing Address - Phone:630-506-2050
Mailing Address - Fax:
Practice Address - Street 1:109 FAIRFIELD WAY
Practice Address - Street 2:SUITE 106
Practice Address - City:BLOOMINGDALE
Practice Address - State:IL
Practice Address - Zip Code:60108-1583
Practice Address - Country:US
Practice Address - Phone:630-506-2050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-23
Last Update Date:2012-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149.0147721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical