Basic Information
| Provider Information | |||||||||
| NPI: | 1255534368 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DASTUR | ||||||||
| FirstName: | SHANA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | L.C.S.W. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 139 FOREST AVE | ||||||||
| Address2: | |||||||||
| City: | WEST CALDWELL | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070067962 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7182083603 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 406 10TH AVE | ||||||||
| Address2: | 9TH FLOOR | ||||||||
| City: | NEW YORK | ||||||||
| State: | NY | ||||||||
| PostalCode: | 100012320 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7184880100 | ||||||||
| FaxNumber: | 2122736507 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/06/2007 | ||||||||
| LastUpdateDate: | 07/09/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | 076100 | NY | N | Behavioral Health & Social Service Providers | Social Worker | 1041C0700X | 078540 | NY | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.