Provider Demographics
NPI:1588035521
Name:FLEIT, SHELLEY A (PHD, LCSW)
Entity Type:Individual
Prefix:
First Name:SHELLEY
Middle Name:A
Last Name:FLEIT
Suffix:
Gender:F
Credentials:PHD, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:348 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SETAUKET
Mailing Address - State:NY
Mailing Address - Zip Code:11733-3800
Mailing Address - Country:US
Mailing Address - Phone:631-941-1200
Mailing Address - Fax:631-941-1201
Practice Address - Street 1:348 MAIN ST
Practice Address - Street 2:
Practice Address - City:SETAUKET
Practice Address - State:NY
Practice Address - Zip Code:11733-3800
Practice Address - Country:US
Practice Address - Phone:631-941-1200
Practice Address - Fax:631-941-1201
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-16
Last Update Date:2015-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0721081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical