Provider Demographics
NPI:1841338902
Name:CHAVIS, SHARMAYNE LASHAWN (LCSW)
Entity type:Individual
Prefix:MS
First Name:SHARMAYNE
Middle Name:LASHAWN
Last Name:CHAVIS
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 1:20 DAVIS CT
Mailing Address - Street 2:
Mailing Address - City:STATEN ISLAND
Mailing Address - State:NY
Mailing Address - Zip Code:10310-1681
Mailing Address - Country:US
Mailing Address - Phone:718-720-6292
Mailing Address - Fax:718-815-3399
Practice Address - Street 1:633 CLOVE RD
Practice Address - Street 2:SUITE 6
Practice Address - City:STATEN ISLAND
Practice Address - State:NY
Practice Address - Zip Code:10310-2736
Practice Address - Country:US
Practice Address - Phone:917-331-0087
Practice Address - Fax:718-815-3399
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0742621041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY05251766Medicaid
NY05251766Medicaid
NY05251766Medicare UPIN