Provider Demographics
NPI:1659522480
Name:KINGSBERRY, SHIRAL (MS, MH)
Entity Type:Individual
Prefix:MS
First Name:SHIRAL
Middle Name:
Last Name:KINGSBERRY
Suffix:
Gender:F
Credentials:MS, MH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 E TREMONT AVE
Mailing Address - Street 2:SUITE #2
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10457-5001
Mailing Address - Country:US
Mailing Address - Phone:718-294-2228
Mailing Address - Fax:718-299-5523
Practice Address - Street 1:715 E TREMONT AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10457-5001
Practice Address - Country:US
Practice Address - Phone:718-294-2228
Practice Address - Fax:718-299-5523
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-10
Last Update Date:2009-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY002014101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health