MEDICARE: SHATEQUA BLACKETT-ROBINSON 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
1	104100000X	Social Worker	095640	NY

General Provider Information

NPI Number	:	1891331294
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHATEQUA BLACKETT-ROBINSON LMSW

Provider Business Mailing Address
First Line	:	445 THOMAS S BOYLAND ST APT 2L
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11212-5012
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	445 THOMAS S BOYLAND ST APT 2L
Second Line	:
City	:	BROOKLYN
State	:	NY
Zip	:	11212-5012
Country	:	US
Telephone Number	:	718-443-3440
Fax Number	:

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

Provider Enumeration Date	:	11/20/2019
Last Update Date	:	11/20/2019

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