Provider Demographics
NPI:1316010796
Name:COURT, SHIRLEY L (LCSW)
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:L
Last Name:COURT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:SHIRLEY
Other - Middle Name:
Other - Last Name:COURT-GONZALEZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW, BCD
Mailing Address - Street 1:269 TICHENOR AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH ORANGE
Mailing Address - State:NJ
Mailing Address - Zip Code:07079-2139
Mailing Address - Country:US
Mailing Address - Phone:212-505-7073
Mailing Address - Fax:917-591-8788
Practice Address - Street 1:412 AVENUE OF THE AMERICAS
Practice Address - Street 2:SUITE 400
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-8409
Practice Address - Country:US
Practice Address - Phone:212-505-7073
Practice Address - Fax:917-591-8788
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR047928-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01925786Medicaid
NYN5M081Medicare ID - Type UnspecifiedNOT ACTIVE AT THIS TIME