Provider Demographics
NPI:1194265694
Name:MUSCI, SHELLEY LOU (LCSW)
Entity type:Individual
Prefix:MRS
First Name:SHELLEY
Middle Name:LOU
Last Name:MUSCI
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 HICKORY PARK ROAD
Mailing Address - Street 2:
Mailing Address - City:CORTLAND
Mailing Address - State:NY
Mailing Address - Zip Code:13045
Mailing Address - Country:US
Mailing Address - Phone:315-778-4611
Mailing Address - Fax:607-299-4349
Practice Address - Street 1:17-29 MAIN ST., MCNEIL BUILDING
Practice Address - Street 2:SUITE 418
Practice Address - City:CORTLAND
Practice Address - State:NY
Practice Address - Zip Code:13045
Practice Address - Country:US
Practice Address - Phone:315-778-4611
Practice Address - Fax:607-299-4349
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-02
Last Update Date:2021-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0916001041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1336163963Medicaid