Provider Demographics
NPI:1629447271
Name:LEMENTOWSKI, ERIN SHOCKEY (PHD)
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:SHOCKEY
Last Name:LEMENTOWSKI
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:
Other - Last Name:SHOCKEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:1025 NORTHERN BLVD
Mailing Address - Street 2:SUITE 214
Mailing Address - City:ROSLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11576-1506
Mailing Address - Country:US
Mailing Address - Phone:516-466-2537
Mailing Address - Fax:516-439-4936
Practice Address - Street 1:1025 NORTHERN BLVD
Practice Address - Street 2:SUITE 214
Practice Address - City:ROSLYN
Practice Address - State:NY
Practice Address - Zip Code:11576-1506
Practice Address - Country:US
Practice Address - Phone:516-466-2537
Practice Address - Fax:516-439-4936
Is Sole Proprietor?:No
Enumeration Date:2015-09-24
Last Update Date:2015-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY021398103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical