Provider Demographics
NPI:1699828004
Name:KARASICK, SHOSHANA (PHD)
Entity Type:Individual
Prefix:
First Name:SHOSHANA
Middle Name:
Last Name:KARASICK
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8344 LEFFERTS BLVD APT 5P
Mailing Address - Street 2:
Mailing Address - City:KEW GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11415-2583
Mailing Address - Country:US
Mailing Address - Phone:718-441-6667
Mailing Address - Fax:
Practice Address - Street 1:8344 LEFFERTS BLVD APT 5P
Practice Address - Street 2:
Practice Address - City:KEW GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11415-2583
Practice Address - Country:US
Practice Address - Phone:718-441-6667
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist