Healthcare Provider Details

I. General information

NPI: 1669127676
Provider Name (Legal Business Name): CHELSEA SHIRAZ SHEPHERD LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MS. CHELSEA SHIRAZ TUSSING

II. Dates (important events)

Enumeration Date: 02/17/2022
Last Update Date: 08/27/2025
Certification Date: 02/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

220 EAST 42ND STREET YAI 8TH FLOOR
NEW YORK NY
10017
US

IV. Provider business mailing address

17 COHAWNEY RD
SCARSDALE NY
10583
US

V. Phone/Fax

Practice location:
  • Phone: 646-276-0741
  • Fax: 718-283-3602
Mailing address:
  • Phone: 914-263-6470
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number092246
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: