Provider Demographics
NPI:1437365780
Name:NELSON, DESHAWN HENRY (MA)
Entity Type:Individual
Prefix:
First Name:DESHAWN
Middle Name:HENRY
Last Name:NELSON
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19106 104TH AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT ALBANS
Mailing Address - State:NY
Mailing Address - Zip Code:11412-1112
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:333 PARK AVE S
Practice Address - Street 2:SUITE 3D
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-2906
Practice Address - Country:US
Practice Address - Phone:212-388-0903
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered103TB0200XBehavioral Health & Social Service ProvidersPsychologistCognitive & Behavioral