Provider Demographics
NPI:1285743443
Name:SILLEKENS, SHIRLEY (LCSW ACSW BCD CAS)
Entity type:Individual
Prefix:MS
First Name:SHIRLEY
Middle Name:
Last Name:SILLEKENS
Suffix:
Gender:F
Credentials:LCSW ACSW BCD CAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13429 166TH PL
Mailing Address - Street 2:APT 13A
Mailing Address - City:JAMAICA
Mailing Address - State:NY
Mailing Address - Zip Code:11434-3844
Mailing Address - Country:US
Mailing Address - Phone:718-527-7742
Mailing Address - Fax:
Practice Address - Street 1:11015 71ST RD
Practice Address - Street 2:SUITE 1J
Practice Address - City:FOREST HILLS
Practice Address - State:NY
Practice Address - Zip Code:11375
Practice Address - Country:US
Practice Address - Phone:718-527-7742
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYPR01304411041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01587544Medicaid
Q18333Medicare UPIN
NY06446Medicare ID - Type Unspecified