Provider Demographics
NPI:1700591914
Name:SHAH, MANISHA (LMSW)
Entity Type:Individual
Prefix:
First Name:MANISHA
Middle Name:
Last Name: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 1:333 E 91ST ST APT 15B
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10128-5887
Mailing Address - Country:US
Mailing Address - Phone:201-683-1619
Mailing Address - Fax:
Practice Address - Street 1:333 E 91ST ST APT 15B
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-5887
Practice Address - Country:US
Practice Address - Phone:201-683-1618
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-23
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY080875104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker