Provider Demographics
NPI:1336432871
Name:SHINFIELD-NOVAK, KELLI (MA, LP)
Entity Type:Individual
Prefix:MS
First Name:KELLI
Middle Name:
Last Name:SHINFIELD-NOVAK
Suffix:
Gender:F
Credentials:MA, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:119 W 57TH ST STE 1211
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10019-2400
Mailing Address - Country:US
Mailing Address - Phone:917-602-0934
Mailing Address - Fax:
Practice Address - Street 1:250 W 57TH ST
Practice Address - Street 2:501
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10107-0001
Practice Address - Country:US
Practice Address - Phone:212-582-1566
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-17
Last Update Date:2020-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000961102L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst