Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 020940 | NY |
N | 1041C0700X | Clinical Social Worker | 076905 | NY |
NPI | 1003143934 |
---|---|
Provider Name | Ms. Shahla Gorovoy |
First Address | Harriman, NY 10926-0439 |
Second Address | Middletown, NY 10940-6440 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/11/2009 |
Last Update Date | 11/02/2019 |