Provider Demographics
NPI:1497213003
Name:JAMISON, SHAVONNE L (LMSW)
Entity Type:Individual
Prefix:MRS
First Name:SHAVONNE
Middle Name:L
Last Name:JAMISON
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:SHAVONNE
Other - Middle Name:
Other - Last Name:LAWSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SHAVONNE LAWSON
Mailing Address - Street 1:438 BAINBRIDGE ST APT 1
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11233-2009
Mailing Address - Country:US
Mailing Address - Phone:347-614-6663
Mailing Address - Fax:
Practice Address - Street 1:2581 ATLANTIC AVE
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11207-2412
Practice Address - Country:US
Practice Address - Phone:718-495-6700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-04
Last Update Date:2019-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY102739104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker