Healthcare Provider Details

I. General information

NPI: 1013065440
Provider Name (Legal Business Name): RUSSELL BRIAN SHELKOWITZ LCSW
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/08/2007
Last Update Date: 04/28/2026
Certification Date: 04/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

251 RICHMOND HILL ROAD HEARTLAND PSYCHOLOGICAL SVCES PC
STATEN ISLAND NY
10314
US

IV. Provider business mailing address

1346 CENTRE RD
RHINEBECK NY
12572-3268
US

V. Phone/Fax

Practice location:
  • Phone: 718-494-9397
  • Fax: 718-761-1000
Mailing address:
  • Phone: 917-838-3607
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number048935
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberR048935 1
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: