Provider Demographics
NPI:1801181565
Name:KAUFMAN DANZIG, SHIRA (PHD)
Entity Type:Individual
Prefix:DR
First Name:SHIRA
Middle Name:
Last Name:KAUFMAN DANZIG
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:SHIRA
Other - Middle Name:TYLA
Other - Last Name:KAUFMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:30 W 70TH ST
Mailing Address - Street 2:SUITE 1A
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023-4636
Mailing Address - Country:US
Mailing Address - Phone:917-318-4001
Mailing Address - Fax:
Practice Address - Street 1:30 W 70TH ST
Practice Address - Street 2:SUITE 1A
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-4636
Practice Address - Country:US
Practice Address - Phone:917-318-4001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-10
Last Update Date:2016-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY019089103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical