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General NPI Number Information
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NPI Number | 1316643455
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Entity Type | Individual
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Provider Name | SHELLETTE HENRY LCSW-R
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Gender | Female
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Dates
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Enumeration Date | 01/31/2023
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Last Update Date | 01/31/2023
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Provider Practice Location Address
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Address Line | 600 E 125TH ST BLDG 108
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City | NEW YORK
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State | NY
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Zip | 10035-6000
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Country | US
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Telephone | 212-831-7007
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Fax | 212-426-7691
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Provider Business Mailing Address
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Address Line | 600 E 125TH ST BLDG 108
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City | NEW YORK
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State | NY
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Zip | 10035-6000
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Country | US
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Telephone | 212-831-7007
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Fax | 212-426-7691
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 054873
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License Number State | NY
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