Provider Demographics
NPI:1821167024
Name:KIVELL, SHARON (CSW)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:KIVELL
Suffix:
Gender:F
Credentials:CSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34 ELM ST
Mailing Address - Street 2:
Mailing Address - City:GREAT NECK
Mailing Address - State:NY
Mailing Address - Zip Code:11021-1941
Mailing Address - Country:US
Mailing Address - Phone:516-829-6269
Mailing Address - Fax:516-487-7218
Practice Address - Street 1:34 ELM ST
Practice Address - Street 2:
Practice Address - City:GREAT NECK
Practice Address - State:NY
Practice Address - Zip Code:11021-1941
Practice Address - Country:US
Practice Address - Phone:516-829-6269
Practice Address - Fax:516-487-7218
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR041725-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical