Provider Demographics
NPI:1265890891
Name:FRIEDLANDER, SHOSHANA (LCSW)
Entity type:Individual
Prefix:
First Name:SHOSHANA
Middle Name:
Last Name:FRIEDLANDER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:SHANI
Other - Middle Name:
Other - Last Name:FRIEDLANDER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:210 WEST 70TH STREET
Mailing Address - Street 2:SUITE 1
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10023
Mailing Address - Country:US
Mailing Address - Phone:646-906-9096
Mailing Address - Fax:
Practice Address - Street 1:210 WEST 70TH STREET
Practice Address - Street 2:SUITE 1
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023
Practice Address - Country:US
Practice Address - Phone:646-906-9096
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-02-10
Last Update Date:2020-01-29
Deactivation Date:2018-01-17
Deactivation Code:
Reactivation Date:2018-02-02
Provider Licenses
StateLicense IDTaxonomies
IL150015110104100000X
NY097004104100000X
NY0884091041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL150015110OtherLICENSED SOCIAL WORKER
NY088409OtherLICENSED CLINICAL SOCIAL WORKER