Provider Demographics
NPI:1992155287
Name:KERCHNER, SHELBY LYNN (LCSW)
Entity type:Individual
Prefix:MS
First Name:SHELBY
Middle Name:LYNN
Last Name:KERCHNER
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 1:372 5TH AVE
Mailing Address - Street 2:APT 8M
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10018-8106
Mailing Address - Country:US
Mailing Address - Phone:917-370-7711
Mailing Address - Fax:212-290-1406
Practice Address - Street 1:372 5TH AVE
Practice Address - Street 2:APT 8M
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10018-8106
Practice Address - Country:US
Practice Address - Phone:917-370-7711
Practice Address - Fax:212-290-1406
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-16
Last Update Date:2022-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY077049-1104100000X
NY093344-011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker