Provider Demographics
NPI:1790157063
Name:CHAN, SHUKWAH (LCSW)
Entity Type:Individual
Prefix:
First Name:SHUKWAH
Middle Name:
Last Name:CHAN
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 1:5751 CLOVERDALE BLVD.,
Mailing Address - Street 2:
Mailing Address - City:OAKLAND GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11364
Mailing Address - Country:US
Mailing Address - Phone:917-353-0002
Mailing Address - Fax:
Practice Address - Street 1:5751 CLOVERDALE BLVD
Practice Address - Street 2:
Practice Address - City:OAKLAND GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11364-2450
Practice Address - Country:US
Practice Address - Phone:917-353-0002
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-27
Last Update Date:2015-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY073947104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker