Provider Demographics
NPI:1992210405
Name:ANDERSON, SHELLEY L (PHD, LCSW-R)
Entity Type:Individual
Prefix:DR
First Name:SHELLEY
Middle Name:L
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:PHD, LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 E HARTSDALE AVE APT 3F
Mailing Address - Street 2:
Mailing Address - City:HARTSDALE
Mailing Address - State:NY
Mailing Address - Zip Code:10530-3528
Mailing Address - Country:US
Mailing Address - Phone:914-723-5899
Mailing Address - Fax:212-988-4706
Practice Address - Street 1:140 RIVERSIDE DR STE 1-O
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10024-2605
Practice Address - Country:US
Practice Address - Phone:212-249-1302
Practice Address - Fax:212-988-4706
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-06
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR-0248641041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty