Provider Demographics
NPI:1205069986
Name:SHOCKNESS, LIONEL R (LCSW)
Entity type:Individual
Prefix:MR
First Name:LIONEL
Middle Name:R
Last Name:SHOCKNESS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 MAIDEN LN
Mailing Address - Street 2:SUITE 320
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10038-4810
Mailing Address - Country:US
Mailing Address - Phone:212-579-6294
Mailing Address - Fax:212-865-7183
Practice Address - Street 1:75 MAIDEN LN
Practice Address - Street 2:SUITE 320
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10038-4810
Practice Address - Country:US
Practice Address - Phone:212-579-6294
Practice Address - Fax:212-865-7183
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-28
Last Update Date:2009-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR049379-11041C0700X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical