Provider Demographics
NPI:1235448044
Name:SHISTER, ANGELA (LCSW)
Entity Type:Individual
Prefix:
First Name:ANGELA
Middle Name:
Last Name:SHISTER
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 1:532 NEPTUNE AVE
Mailing Address - Street 2:RM 200
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11224-4010
Mailing Address - Country:US
Mailing Address - Phone:718-946-2600
Mailing Address - Fax:718-946-0226
Practice Address - Street 1:532 NEPTUNE AVE
Practice Address - Street 2:RM 200
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11224-4010
Practice Address - Country:US
Practice Address - Phone:718-946-2600
Practice Address - Fax:718-946-0226
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-28
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR043689-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical