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NPI Code Detail

MEDICARE: STEPHANIE SHELTON LMSW

MEDICARE: STEPHANIE SHELTON LMSW
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
1101YA0400XAddiction (Substance Use Disorder) Counselor
2104100000XSocial Worker106118-1NY

General Provider Information

NPI Number : 1740421577
Entity Type Code : Individual
Provider Name (Legal Business Name) : STEPHANIE SHELTON LMSW
Provider Business Mailing Address
First Line : 1125 FULTON ST STE 2
Second Line :
City : BROOKLYN
State : NY
Zip : 11238-2669
Country : US
Telephone Number : 347-226-9025
Fax Number : 212-627-4040
Provider Business Practice Location Address
First Line : 1125 FULTON ST STE 2
Second Line :
City : BROOKLYN
State : NY
Zip : 11238-2669
Country : US
Telephone Number : 347-226-9025
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/06/2009
Last Update Date : 04/03/2023

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