Provider Demographics
NPI:1689685356
Name:SHAMITZ, ROBERTA EMILY (LCSW)
Entity Type:Individual
Prefix:MS
First Name:ROBERTA
Middle Name:EMILY
Last Name:SHAMITZ
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ROBIN
Other - Middle Name:
Other - Last Name:SHAMITZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2708 CLUBHOUSE ROAD
Mailing Address - Street 2:
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566
Mailing Address - Country:US
Mailing Address - Phone:516-546-2150
Mailing Address - Fax:
Practice Address - Street 1:2708 CLUBHOUSE ROAD
Practice Address - Street 2:
Practice Address - City:MERRICK
Practice Address - State:NY
Practice Address - Zip Code:11566
Practice Address - Country:US
Practice Address - Phone:516-867-2302
Practice Address - Fax:516-867-3459
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR042402-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical