Provider Demographics
NPI:1750049763
Name:OUTLAW, SHEMICA A
Entity type:Individual
Prefix:MS
First Name:SHEMICA
Middle Name:A
Last Name:OUTLAW
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 1:1451 WASHINGTON AVE APT 15D
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10456-1944
Mailing Address - Country:US
Mailing Address - Phone:646-410-5224
Mailing Address - Fax:
Practice Address - Street 1:419 E 93RD ST APT 17H
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10128-6942
Practice Address - Country:US
Practice Address - Phone:413-591-8068
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-07
Last Update Date:2021-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health