MEDICARE: SHIRLEY CHEN

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	100066	NY
2	1041C0700X	Clinical Social Worker	091525	NY

General Provider Information

NPI Number	:	1851939433
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHIRLEY CHEN

Provider Business Mailing Address
First Line	:	230 CLINTON ST APT 14H
Second Line	:
City	:	NEW YORK
State	:	NY
Zip	:	10002-7522
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3069 44TH ST
Second Line	:
City	:	LONG ISLAND CITY
State	:	NY
Zip	:	11103-2220
Country	:	US
Telephone Number	:	929-274-1661
Fax Number	:

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

Provider Enumeration Date	:	12/14/2019
Last Update Date	:	10/12/2021

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Directions to “ SHIRLEY CHEN ” Practice Location

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