Provider Demographics
NPI:1154830545
Name:CHANNAN, LOKMATTIE SHELLY (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:LOKMATTIE
Middle Name:SHELLY
Last Name:CHANNAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:MS
Other - First Name:LOKMATTIE
Other - Middle Name:SHELLY
Other - Last Name:DHARAMDAT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:6530 108TH ST
Mailing Address - Street 2:
Mailing Address - City:FOREST HILLS
Mailing Address - State:NY
Mailing Address - Zip Code:11375-2255
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6530 108TH ST
Practice Address - Street 2:
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375-2255
Practice Address - Country:US
Practice Address - Phone:347-803-3493
Practice Address - Fax:347-803-3493
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-28
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY101215-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty