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General NPI Number Information
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NPI Number | 1578089926
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Entity Type | Individual
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Provider Name | ISABEL JO SHANAHAN
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Gender | Female
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Dates
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Enumeration Date | 08/17/2017
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Last Update Date | 08/17/2017
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Provider Practice Location Address
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Address Line | 190 N 10TH ST STE 301
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City | BROOKLYN
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State | NY
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Zip | 11211-9317
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Country | US
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Telephone | 917-293-4642
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Fax |
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Provider Business Mailing Address
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Address Line | 215 SAINT NICHOLAS AVE
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City | BROOKLYN
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State | NY
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Zip | 11237-4840
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Country | US
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Telephone | 505-310-4619
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 002062
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License Number State | NY
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