Active NPI
Michelle(Shelly) Petnov-Sherman, LCSW
- Clinical Social Worker
- New York, NY
National Provider Identifier
1093870834
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- R037234-1
- Practice address
- 2000 Broadway
Suite 10G
New York, NY 10023-5028 - Phone
- (212) 595-5210
- Fax
- (212) 595-5545
- NPI assigned
- Dec 22, 2006
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Social Worker | 1041C0700X | R037234-1 | NY | Primary |
Addresses
Primary practice location
2000 Broadway
Suite 10G
New York, NY 10023-5028
Mailing address
2000 Broadway
Suite 10G
New York, NY 10023-5028
Phone (212) 595-5210
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R037234-1 | NY | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1166745600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1093870834",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2000 BROADWAY",
"address_2": "SUITE 10G",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100235028",
"telephone_number": "212-595-5210",
"fax_number": "212-595-5545"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2000 BROADWAY",
"address_2": "SUITE 10G",
"city": "NEW YORK",
"state": "NY",
"postal_code": "100235028",
"telephone_number": "212-595-5210",
"fax_number": "212-595-5545"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PETNOV-SHERMAN",
"first_name": "MICHELLE(SHELLY)",
"name_prefix": "Ms.",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-12-22",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NY",
"license": "R037234-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in New York, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.