Provider Demographics
NPI:1407441520
Name:VARNER, SHANIQUA VIOLA
Entity Type:Individual
Prefix:
First Name:SHANIQUA
Middle Name:VIOLA
Last Name:VARNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 W 52ND ST APT 11AS
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-7773
Mailing Address - Country:US
Mailing Address - Phone:646-737-6866
Mailing Address - Fax:
Practice Address - Street 1:525 W 52ND ST APT 11AS
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-7773
Practice Address - Country:US
Practice Address - Phone:646-737-6866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-02
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY111538104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker