Provider Demographics
NPI:1477708121
Name:DIPAOLA-SHAH, MARY (LMSW)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:
Last Name:DIPAOLA-SHAH
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 LOUISA CT
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:NY
Mailing Address - Zip Code:11768-3062
Mailing Address - Country:US
Mailing Address - Phone:631-988-1302
Mailing Address - Fax:
Practice Address - Street 1:125 E BETHPAGE RD
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:NY
Practice Address - Zip Code:11803-4228
Practice Address - Country:US
Practice Address - Phone:516-731-5588
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-11-21
Last Update Date:2008-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY068880104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker