Provider Demographics
NPI:1346633773
Name:SIMKHAI, SHIRIN D (LMSW)
Entity Type:Individual
Prefix:
First Name:SHIRIN
Middle Name:D
Last Name:SIMKHAI
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 1:58 SUGAR MAPLE DR
Mailing Address - Street 2:
Mailing Address - City:ROSLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11576-3229
Mailing Address - Country:US
Mailing Address - Phone:917-488-8475
Mailing Address - Fax:
Practice Address - Street 1:58 SUGAR MAPLE DR
Practice Address - Street 2:
Practice Address - City:ROSLYN
Practice Address - State:NY
Practice Address - Zip Code:11576-3229
Practice Address - Country:US
Practice Address - Phone:917-488-8475
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-10
Last Update Date:2015-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY091814-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker