Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | NY | |
N | 101YS0200X | School Counselor |
NPI | 1063838365 |
---|---|
Provider Name | Makeda Shaw |
First Address | Brooklyn, NY 11225-4347 |
Second Address | Brooklyn, NY 11225-4347 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/03/2014 |
Last Update Date | 11/03/2014 |