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General NPI Number Information
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NPI Number | 1356015127
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Entity Type | Individual
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Provider Name | CRISTINA SHEA LCSW
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Gender | Female
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Dates
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Enumeration Date | 08/05/2021
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Last Update Date | 05/12/2025
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Provider Practice Location Address
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Address Line | 133 W 33RD ST STE 11B
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City | NEW YORK
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State | NY
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Zip | 10001-2903
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Country | US
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Telephone | 646-883-6639
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Fax |
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Provider Business Mailing Address
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Address Line | 719 AVENUE E APT 2
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City | BAYONNE
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State | NJ
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Zip | 07002-4029
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Country | US
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Telephone | 860-881-9056
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Fax |
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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 | 099112
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License Number State | NY
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