Provider Demographics
NPI:1407993272
Name:SHAH, RESHMA RAJESH (LCSW)
Entity type:Individual
Prefix:MRS
First Name:RESHMA
Middle Name:RAJESH
Last Name:SHAH
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 1:8111 45TH AVE APT 6D
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-3517
Mailing Address - Country:US
Mailing Address - Phone:718-205-0463
Mailing Address - Fax:
Practice Address - Street 1:8708 JUSTICE AVE STE C7
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-4590
Practice Address - Country:US
Practice Address - Phone:718-899-9810
Practice Address - Fax:718-899-9699
Is Sole Proprietor?:No
Enumeration Date:2007-01-31
Last Update Date:2015-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY073579-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1041C0700XOtherSOCIAL WORKER CLINICAL