Provider Demographics
NPI:1124304779
Name:SHANBERG, RIKKI BLAIR (LMSW)
Entity type:Individual
Prefix:MRS
First Name:RIKKI
Middle Name:BLAIR
Last Name:SHANBERG
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:177 LIVINGSTON ST
Mailing Address - Street 2:LOWER LEVEL
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11201-7000
Mailing Address - Country:US
Mailing Address - Phone:718-855-7707
Mailing Address - Fax:
Practice Address - Street 1:177 LIVINGSTON ST
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11201-7000
Practice Address - Country:US
Practice Address - Phone:718-855-7707
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-10-27
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY081941104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker