Provider Demographics
NPI:1619759016
Name:BYRON, SHAUNTEE' LATRIECE (MSCJ, LMSW, DSW SIFI)
Entity Type:Individual
Prefix:DR
First Name:SHAUNTEE'
Middle Name:LATRIECE
Last Name:BYRON
Suffix:
Gender:F
Credentials:MSCJ, LMSW, DSW SIFI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:390 E 158TH ST APT 2F
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10451-4468
Mailing Address - Country:US
Mailing Address - Phone:347-972-3273
Mailing Address - Fax:
Practice Address - Street 1:390 E 158TH ST APT 2F
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451-4468
Practice Address - Country:US
Practice Address - Phone:347-972-3273
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-19
Last Update Date:2023-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY112332-01104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker