Provider Demographics
NPI:1396375648
Name:SHAH, NIRA (LMHC)
Entity Type:Individual
Prefix:MS
First Name:NIRA
Middle Name:
Last Name:SHAH
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3069 HOBART ST APT 3P
Mailing Address - Street 2:
Mailing Address - City:WOODSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11377-1456
Mailing Address - Country:US
Mailing Address - Phone:908-304-3574
Mailing Address - Fax:
Practice Address - Street 1:3069 HOBART ST APT 3P
Practice Address - Street 2:
Practice Address - City:WOODSIDE
Practice Address - State:NY
Practice Address - Zip Code:11377-1456
Practice Address - Country:US
Practice Address - Phone:908-304-3574
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-24
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010095101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health