MEDICARE: MRS. LOKMATTIE SHELLY CHANNAN LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	104100000X	Social Worker	101215-1	NY

General Provider Information

NPI Number	:	1154830545
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. LOKMATTIE SHELLY CHANNAN LCSW

Provider Business Mailing Address
First Line	:	6530 108TH ST
Second Line	:
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-2255
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6530 108TH ST
Second Line	:
City	:	FOREST HILLS
State	:	NY
Zip	:	11375-2255
Country	:	US
Telephone Number	:	347-803-3493
Fax Number	:	347-803-3493

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/28/2017
Last Update Date	:	06/17/2022

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