Healthcare Provider Details

I. General information

NPI: 1174245138
Provider Name (Legal Business Name): SHAMIKA MARIE CHARLES LMSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2022
Last Update Date: 06/08/2026
Certification Date: 06/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2094 PITKIN AVE
BROOKLYN NY
11207-3509
US

IV. Provider business mailing address

2094 PITKIN AVE
BROOKLYN NY
11207-3509
US

V. Phone/Fax

Practice location:
  • Phone: 718-240-0600
  • Fax:
Mailing address:
  • Phone: 718-240-0600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number103251
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: