Provider Demographics
NPI:1336474261
Name:BULOW, SHOSHANA M (LCSW, PHD)
Entity type:Individual
Prefix:
First Name:SHOSHANA
Middle Name:M
Last Name:BULOW
Suffix:
Gender:F
Credentials:LCSW, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4520 WALDO AVE
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10471-3942
Mailing Address - Country:US
Mailing Address - Phone:212-696-8679
Mailing Address - Fax:
Practice Address - Street 1:4520 WALDO AVE
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10471-3942
Practice Address - Country:US
Practice Address - Phone:212-696-8679
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-09
Last Update Date:2022-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR0567211041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical