Active NPI
Khatima Shah, LCSW
- Clinical Social Worker
- South Ozone Park, NY
National Provider Identifier
1215108014
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Social Worker
- License
- 074145-1
- Practice address
- 13359 116TH St
South Ozone Park, NY 11420-3112 - Phone
- (917) 714-7248
- Fax
- (718) 848-5952
- NPI assigned
- Mar 19, 2008
- 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 | 074145-1 | NY | Primary |
Addresses
Primary practice location
13359 116TH St
South Ozone Park, NY 11420-3112
Mailing address
13359 116TH St
South Ozone Park, NY 11420-3112
Phone (917) 714-7248
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)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 074145-1 | NY | MD | Clinical Social Worker |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1205884800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1205884800000",
"number": "1215108014",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "13359 116TH ST",
"city": "SOUTH OZONE PARK",
"state": "NY",
"postal_code": "114203112",
"telephone_number": "917-714-7248",
"fax_number": "718-848-5952"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "13359 116TH ST",
"city": "SOUTH OZONE PARK",
"state": "NY",
"postal_code": "114203112",
"telephone_number": "917-714-7248",
"fax_number": "718-848-5952"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHAH",
"first_name": "KHATIMA",
"name_prefix": "Ms.",
"credential": "LCSW",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-03-19",
"last_updated": "2008-03-19",
"status": "A"
},
"taxonomies": [
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NY",
"license": "074145-1",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in South Ozone Park, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 19, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.