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NPI Code Detail

MEDICARE: EQUANIMITY PSYCHOTHERAPY LCSW PLLC

MEDICARE: EQUANIMITY PSYCHOTHERAPY LCSW PLLC
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
11041C0700XClinical Social Worker

General Provider Information

NPI Number : 1871428268
Entity Type Code : Organization
Provider Name (Legal Business Name) : EQUANIMITY PSYCHOTHERAPY LCSW PLLC
Provider Business Mailing Address
First Line : 292 SAINT JOHNS PL APT 54
Second Line :
City : BROOKLYN
State : NY
Zip : 11238-5625
Country : US
Telephone Number : 443-695-0617
Fax Number :
Provider Business Practice Location Address
First Line : 292 SAINT JOHNS PL APT 54
Second Line :
City : BROOKLYN
State : NY
Zip : 11238-5625
Country : US
Telephone Number : 443-695-0617
Fax Number :
Authorized Official
Title or Position : OWNER
Name : JONATHAN SHEDLO
Credential : LCSW
Telephone Number : 443-695-0617
Provider Enumeration Date : 06/16/2026
Last Update Date : 06/16/2026

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