Provider Demographics
NPI:1609015536
Name:SHAKESPEARE & MUSCENTE LCSW, PLLC
Entity Type:Organization
Organization Name:SHAKESPEARE & MUSCENTE LCSW, PLLC
Other - Org Name:LIFE STAGES COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CERTIFIED SOCIAL WORKER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:MUSCENTE
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-R
Authorized Official - Phone:607-256-4422
Mailing Address - Street 1:122 W COURT ST STE 109
Mailing Address - Street 2:
Mailing Address - City:ITHACA
Mailing Address - State:NY
Mailing Address - Zip Code:14850-4165
Mailing Address - Country:US
Mailing Address - Phone:607-256-4422
Mailing Address - Fax:
Practice Address - Street 1:122 W COURT ST STE 109
Practice Address - Street 2:
Practice Address - City:ITHACA
Practice Address - State:NY
Practice Address - Zip Code:14850-4165
Practice Address - Country:US
Practice Address - Phone:607-256-4422
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-17
Last Update Date:2010-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053368R251S00000X
NYPR053077-1251S00000X
NY045779R251S00000X
NY032365R251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health