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General NPI Number Information
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NPI Number | 1841819844
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Entity Type | Individual
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Provider Name | SHANNON EASTHAM DE YCAZA LMHC
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Gender | Female
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Dates
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Enumeration Date | 04/10/2020
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Last Update Date | 02/14/2022
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Provider Practice Location Address
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Address Line | 353 LEXINGTON AVE SUITE 302
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City | NEW YORK
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State | NY
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Zip | 10016
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Country | US
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Telephone | 646-397-0486
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Fax |
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Provider Business Mailing Address
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Address Line | 25 OLD KINGS HWY N STE 13
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City | DARIEN
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State | CT
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Zip | 06820-4608
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Country | US
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Telephone | 646-397-0486
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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 | 010379
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License Number State | NY
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