Provider Demographics
NPI:1841454402
Name:REID, SHOSHONNA SIMONE (LMSW)
Entity type:Individual
Prefix:
First Name:SHOSHONNA
Middle Name:SIMONE
Last Name:REID
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:SIMONE
Other - Middle Name:S
Other - Last Name:REID
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMSW
Mailing Address - Street 1:116 JOHN ST
Mailing Address - Street 2:27TH FLOOR
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10038-3300
Mailing Address - Country:US
Mailing Address - Phone:212-964-0128
Mailing Address - Fax:212-964-0112
Practice Address - Street 1:116 JOHN ST
Practice Address - Street 2:27TH FLOOR
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10038-3300
Practice Address - Country:US
Practice Address - Phone:212-964-0128
Practice Address - Fax:212-964-0112
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-14
Last Update Date:2010-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY017589-1104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker