Provider Demographics
NPI:1164976403
Name:ROSENBAUM, SHIRA NIFLAAH (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:SHIRA
Middle Name:NIFLAAH
Last Name:ROSENBAUM
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:699 W 239TH ST
Mailing Address - Street 2:APT 5D
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-1246
Mailing Address - Country:US
Mailing Address - Phone:240-476-1125
Mailing Address - Fax:
Practice Address - Street 1:699 W 239TH ST
Practice Address - Street 2:APT 5D
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10463-1246
Practice Address - Country:US
Practice Address - Phone:240-476-1125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-03
Last Update Date:2016-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY72 095416104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker