MEDICARE: SHENAY JANELLE TOLES LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	076268	NY
2	1041C0700X	Clinical Social Worker	096967	NY

General Provider Information

NPI Number	:	1225208929
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHENAY JANELLE TOLES LCSW

Provider Business Mailing Address
First Line	:	13721 ADIOS PASS
Second Line	:
City	:	CARMEL
State	:	IN
Zip	:	46032-1203
Country	:	US
Telephone Number	:	516-410-5723
Fax Number	:

Provider Business Practice Location Address
First Line	:	2578 BROADWAY STE 536
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10025-5642
Country	:	US
Telephone Number	:	917-342-2346
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/10/2008
Last Update Date	:	02/23/2024

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