Provider Demographics
NPI:1083710859
Name:SHAKHMUROV, MARGARITA (LCSW)
Entity Type:Individual
Prefix:
First Name:MARGARITA
Middle Name:
Last Name:SHAKHMUROV
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 1:873 CHERRY LN
Mailing Address - Street 2:
Mailing Address - City:VALLEY STREAM
Mailing Address - State:NY
Mailing Address - Zip Code:11581-2722
Mailing Address - Country:US
Mailing Address - Phone:516-295-0828
Mailing Address - Fax:516-295-0828
Practice Address - Street 1:9876 QUEENS BLVD
Practice Address - Street 2:SUITE 1C
Practice Address - City:REGO PARK
Practice Address - State:NY
Practice Address - Zip Code:11374-4356
Practice Address - Country:US
Practice Address - Phone:917-846-2538
Practice Address - Fax:516-295-0828
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR558551041C0700X
NYR55855-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY06473Medicare ID - Type Unspecified