Provider Demographics
NPI:1356015127
Name:SHEA, CRISTINA (MS, LMSW)
Entity Type:Individual
Prefix:
First Name:CRISTINA
Middle Name:
Last Name:SHEA
Suffix:
Gender:F
Credentials:MS, LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 220062
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11222-0062
Mailing Address - Country:US
Mailing Address - Phone:929-306-6928
Mailing Address - Fax:929-419-9061
Practice Address - Street 1:302 5TH AVE FL 8
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-3604
Practice Address - Country:US
Practice Address - Phone:929-306-6928
Practice Address - Fax:929-419-9061
Is Sole Proprietor?:No
Enumeration Date:2021-08-05
Last Update Date:2023-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1134371041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical