Healthcare Provider Details

I. General information

NPI: 1639629660
Provider Name (Legal Business Name): SHAWANA CARTER LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2016
Last Update Date: 10/13/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 JEROME AVE 2ND FLOOR
BRONX NY
10467-1052
US

IV. Provider business mailing address

3600 JEROME AVE 2ND FLOOR
BRONX NY
10467-1052
US

V. Phone/Fax

Practice location:
  • Phone: 718-881-7600
  • Fax: 718-654-1465
Mailing address:
  • Phone: 718-881-7600
  • Fax: 718-654-1465

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number095108
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: