Provider Demographics
NPI:1215061866
Name:SHYDO, HEIDI (LCSW)
Entity type:Individual
Prefix:
First Name:HEIDI
Middle Name:
Last Name:SHYDO
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 1:40 W 95TH ST
Mailing Address - Street 2:APT. 3E
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10025-8510
Mailing Address - Country:US
Mailing Address - Phone:631-495-5474
Mailing Address - Fax:
Practice Address - Street 1:25 CENTRAL PARK W
Practice Address - Street 2:SUITE 1U
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10023-7253
Practice Address - Country:US
Practice Address - Phone:347-732-1005
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-15
Last Update Date:2012-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0766801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical