Provider Demographics
NPI:1558778480
Name:PAUL GOOD SHEPHERD LLC
Entity Type:Organization
Organization Name:PAUL GOOD SHEPHERD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:USUNGU
Authorized Official - Middle Name:
Authorized Official - Last Name:DIMANDJA
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:718-345-5747
Mailing Address - Street 1:2342 DEAN ST FL 2
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11233-4302
Mailing Address - Country:US
Mailing Address - Phone:718-345-5747
Mailing Address - Fax:
Practice Address - Street 1:2342 DEAN ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11233-4302
Practice Address - Country:US
Practice Address - Phone:718-345-5747
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-11
Last Update Date:2014-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Multi-Specialty