Provider Demographics
NPI:1891853719
Name:BIRD, SHARLENE (PSYD)
Entity Type:Individual
Prefix:
First Name:SHARLENE
Middle Name:
Last Name:BIRD
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 W 56TH ST
Mailing Address - Street 2:SUITE 15-S
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-3841
Mailing Address - Country:US
Mailing Address - Phone:212-582-3614
Mailing Address - Fax:
Practice Address - Street 1:112 W 56TH ST
Practice Address - Street 2:SUITE 15-S
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-3841
Practice Address - Country:US
Practice Address - Phone:212-582-3614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY011856103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYV2J331Medicare ID - Type Unspecified