Healthcare Provider Details

I. General information

NPI: 1164054672
Provider Name (Legal Business Name): ALLA R SHAPIRO LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2020
Last Update Date: 02/12/2020
Certification Date: 02/12/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

460 LENOX RD
BROOKLYN NY
11203-2050
US

IV. Provider business mailing address

450 CLARKSON AVE. MSC#80
BROOKLYN NY
11203
US

V. Phone/Fax

Practice location:
  • Phone: 718-270-2957
  • Fax: 718-270-8223
Mailing address:
  • Phone: 718-613-8481
  • Fax: 718-613-8498

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number010133
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: