Provider Demographics
NPI:1750458592
Name:SHELBY, JODY ANN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:JODY
Middle Name:ANN
Last Name:SHELBY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 MILBURN STREET
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE CENTRE
Mailing Address - State:NY
Mailing Address - Zip Code:11570
Mailing Address - Country:US
Mailing Address - Phone:516-678-0313
Mailing Address - Fax:516-255-0036
Practice Address - Street 1:165 NORTH VILLAGE AVENUE
Practice Address - Street 2:SUITE 137
Practice Address - City:ROCKVILLE CENTRE
Practice Address - State:NY
Practice Address - Zip Code:11570
Practice Address - Country:US
Practice Address - Phone:516-678-0313
Practice Address - Fax:516-255-0036
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0323761104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
11497548OtherOXFORD HEALTH PLANS
7268737OtherAETNA BEHAVIORAL HEALTH
7268737OtherAETNA BEHAVIORAL HEALTH
NYN26A31Medicare ID - Type Unspecified