Provider Demographics
NPI:1417473208
Name:STUDER, SHELLY (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:SHELLY
Middle Name:
Last Name:STUDER
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:PO BOX 221
Mailing Address - Street 2:
Mailing Address - City:ORISKANY FALLS
Mailing Address - State:NY
Mailing Address - Zip Code:13425-0221
Mailing Address - Country:US
Mailing Address - Phone:315-570-7161
Mailing Address - Fax:315-306-4093
Practice Address - Street 1:2709 GENESEE ST
Practice Address - Street 2:
Practice Address - City:UTICA
Practice Address - State:NY
Practice Address - Zip Code:13501-6222
Practice Address - Country:US
Practice Address - Phone:315-570-7161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-14
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY098945-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker