Provider Demographics
NPI:1982170981
Name:GILLIAM, SHURAYER (LMSW)
Entity type:Individual
Prefix:
First Name:SHURAYER
Middle Name:
Last Name:GILLIAM
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:340 WILLIAMS AVE APT 4D
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11207-3932
Mailing Address - Country:US
Mailing Address - Phone:929-365-6653
Mailing Address - Fax:
Practice Address - Street 1:480 NORTH ST
Practice Address - Street 2:
Practice Address - City:MIDDLETOWN
Practice Address - State:NY
Practice Address - Zip Code:10940-4504
Practice Address - Country:US
Practice Address - Phone:845-239-4541
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-17
Last Update Date:2024-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
NY1143951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical