Basic Information
Provider Information
NPI: 1003143934
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: GOROVOY
FirstName: SHAHLA
MiddleName:  
NamePrefix: MS.
NameSuffix:  
Credential: LCSW
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: P.O.BOX 439
Address2:  
City: HARRIMAN
State: NY
PostalCode: 109260439
CountryCode: US
TelephoneNumber: 8453256202
FaxNumber:  
Practice Location
Address1: 41 DOLSON AVE STE A
Address2:  
City: MIDDLETOWN
State: NY
PostalCode: 109406440
CountryCode: US
TelephoneNumber: 8453256202
FaxNumber:  
Other Information
ProviderEnumerationDate: 11/13/2009
LastUpdateDate: 02/11/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
1041C0700X020940NYY Behavioral Health & Social Service ProvidersSocial WorkerClinical
1041C0700X076905NYN Behavioral Health & Social Service ProvidersSocial WorkerClinical

No ID Information.


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