Provider Demographics
NPI:1508986548
Name:SHULL, ELIZABETH MAY (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:MAY
Last Name:SHULL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:122 E 82ND ST
Mailing Address - Street 2:2B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10028-0822
Mailing Address - Country:US
Mailing Address - Phone:212-988-4063
Mailing Address - Fax:212-988-7395
Practice Address - Street 1:344 W 36TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10018-7598
Practice Address - Country:US
Practice Address - Phone:212-560-6700
Practice Address - Fax:212-244-2034
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-31
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPO47254-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
N8M041Medicare PIN