Provider Demographics
NPI:1780875203
Name:DAVIDOR, SHELLY (LCSW)
Entity type:Individual
Prefix:MS
First Name:SHELLY
Middle Name:
Last Name:DAVIDOR
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:255 15TH ST
Mailing Address - Street 2:SUITE 103, BASEMENT LEVEL
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11215-4988
Mailing Address - Country:US
Mailing Address - Phone:718-788-5101
Mailing Address - Fax:
Practice Address - Street 1:255 15TH ST
Practice Address - Street 2:SUITE 103, BASEMENT LEVEL
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11215-4988
Practice Address - Country:US
Practice Address - Phone:718-788-5101
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-08
Last Update Date:2012-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker