Provider Demographics
NPI:1891405353
Name:POWELL, SHANTEL LORRAINE (PHD)
Entity Type:Individual
Prefix:DR
First Name:SHANTEL
Middle Name:LORRAINE
Last Name:POWELL
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 1:6 S LAKE AVE APT N2
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:NY
Mailing Address - Zip Code:12203-1137
Mailing Address - Country:US
Mailing Address - Phone:772-370-4556
Mailing Address - Fax:
Practice Address - Street 1:6 S LAKE AVE APT N2
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:NY
Practice Address - Zip Code:12203-1137
Practice Address - Country:US
Practice Address - Phone:772-370-4556
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-11-24
Last Update Date:2022-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY024999103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling