Provider Demographics
NPI:1629688932
Name:BORHARA, SHIVANI MALHOTRA (MFT)
Entity Type:Individual
Prefix:
First Name:SHIVANI
Middle Name:MALHOTRA
Last Name:BORHARA
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:SHIVANI
Other - Middle Name:
Other - Last Name:MALHOTRA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MFT
Mailing Address - Street 1:4710 111TH ST FL 2
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:NY
Mailing Address - Zip Code:11368-2921
Mailing Address - Country:US
Mailing Address - Phone:347-421-2227
Mailing Address - Fax:
Practice Address - Street 1:4710 111TH ST FL 2
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:NY
Practice Address - Zip Code:11368-2921
Practice Address - Country:US
Practice Address - Phone:347-421-2227
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-03
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY001208101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health