Provider Demographics
NPI:1245912260
Name:PERLMUTTER, SHOSHANA MALKA
Entity type:Individual
Prefix:
First Name:SHOSHANA
Middle Name:MALKA
Last Name:PERLMUTTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8 DUNNIGAN DR
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:NY
Mailing Address - Zip Code:10970-2659
Mailing Address - Country:US
Mailing Address - Phone:845-729-6488
Mailing Address - Fax:
Practice Address - Street 1:8 DUNNIGAN DR
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:NY
Practice Address - Zip Code:10970-2659
Practice Address - Country:US
Practice Address - Phone:973-836-8009
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-01
Last Update Date:2023-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY113843104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker