Provider Demographics
NPI:1235725771
Name:BELISLE, SHOSHANA SILVERMAN (LMSW)
Entity Type:Individual
Prefix:
First Name:SHOSHANA
Middle Name:SILVERMAN
Last Name:BELISLE
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 1:632 COLLEGE HILL RD
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:VT
Mailing Address - Zip Code:05091-3006
Mailing Address - Country:US
Mailing Address - Phone:917-494-9663
Mailing Address - Fax:
Practice Address - Street 1:200 PROSPECT PARK W
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-5747
Practice Address - Country:US
Practice Address - Phone:212-621-7770
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-18
Last Update Date:2020-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY067858104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker