Provider Demographics
NPI:1467514281
Name:SHAPIRO, ELLEN M (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ELLEN
Middle Name:M
Last Name:SHAPIRO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 W 95TH ST
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-6611
Mailing Address - Country:US
Mailing Address - Phone:212-580-4412
Mailing Address - Fax:212-792-6058
Practice Address - Street 1:150 W 95TH ST
Practice Address - Street 2:SUITE 1A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10025-6611
Practice Address - Country:US
Practice Address - Phone:212-580-4412
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-15
Last Update Date:2014-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR0217101041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0006502OtherGHI
NY081044OtherVALUE OPTIONS
NYN3253Medicare ID - Type Unspecified