Provider Demographics
NPI:1205267853
Name:BROWN, SHYAVIA (LMSW, CASAC-T)
Entity type:Individual
Prefix:
First Name:SHYAVIA
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:LMSW, CASAC-T
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 SHERIDAN AVE
Mailing Address - Street 2:APT. 3C
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10451-3390
Mailing Address - Country:US
Mailing Address - Phone:646-427-9846
Mailing Address - Fax:
Practice Address - Street 1:329 E 149TH ST
Practice Address - Street 2:4TH FLOOR
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10451-5601
Practice Address - Country:US
Practice Address - Phone:718-769-2698
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-09
Last Update Date:2013-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY089409-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker