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General NPI Number Information
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NPI Number | 1992210405
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Entity Type | Individual
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Provider Name | SHELLEY L. ANDERSON PH.D., LCSW-R
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Gender | Female
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Dates
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Enumeration Date | 12/06/2017
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 140 RIVERSIDE DR STE 1-O
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City | NEW YORK
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State | NY
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Zip | 10024-2605
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Country | US
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Telephone | 212-249-1302
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Fax | 212-988-4706
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Provider Business Mailing Address
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Address Line | 150 E HARTSDALE AVE APT 3F
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City | HARTSDALE
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State | NY
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Zip | 10530-3528
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Country | US
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Telephone | 914-723-5899
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Fax | 212-988-4706
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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 | PR-024864
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License Number State | NY
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