Provider Demographics
NPI:1831403690
Name:SERABIAN, SHAMSIL HAZARIKA (LCSW)
Entity type:Individual
Prefix:
First Name:SHAMSIL
Middle Name:HAZARIKA
Last Name:SERABIAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:SHAMSIL
Other - Middle Name:
Other - Last Name:HAZARIKA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:34 WEST 22ND STREET
Mailing Address - Street 2:SUITE 2F
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10010
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:34 WEST 22ND STREET
Practice Address - Street 2:SUITE 2F
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010
Practice Address - Country:US
Practice Address - Phone:347-674-1297
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-03
Last Update Date:2018-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY081726104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker