Provider Demographics
NPI:1619981404
Name:SHAMAH, ISAAC (LCSW)
Entity Type:Individual
Prefix:MR
First Name:ISAAC
Middle Name:
Last Name:SHAMAH
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 NORTH BROADWAY
Mailing Address - Street 2:
Mailing Address - City:NYACK
Mailing Address - State:NY
Mailing Address - Zip Code:10960-1618
Mailing Address - Country:US
Mailing Address - Phone:845-641-9041
Mailing Address - Fax:845-358-3006
Practice Address - Street 1:219 N BROADWAY
Practice Address - Street 2:
Practice Address - City:NYACK
Practice Address - State:NY
Practice Address - Zip Code:10960-1618
Practice Address - Country:US
Practice Address - Phone:845-358-0188
Practice Address - Fax:845-358-3006
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY076737-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical