Provider Demographics
NPI:1679975833
Name:TYLUS, SHEILA (LICSW)
Entity type:Individual
Prefix:
First Name:SHEILA
Middle Name:
Last Name:TYLUS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 WADSWORTH ST
Mailing Address - Street 2:
Mailing Address - City:DANVERS
Mailing Address - State:MA
Mailing Address - Zip Code:01923-1954
Mailing Address - Country:US
Mailing Address - Phone:978-518-2607
Mailing Address - Fax:
Practice Address - Street 1:12 WADSWORTH ST
Practice Address - Street 2:
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-1954
Practice Address - Country:US
Practice Address - Phone:978-518-2607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-19
Last Update Date:2014-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1137481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical