Provider Demographics
NPI:1053370924
Name:SHAFIRO, MARINA (LCSW - R)
Entity type:Individual
Prefix:MRS
First Name:MARINA
Middle Name:
Last Name:SHAFIRO
Suffix:
Gender:F
Credentials:LCSW - R
Other - Prefix:
Other - First Name:MARINA
Other - Middle Name:
Other - Last Name:KHURGINA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2037 E 35TH ST
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11234-4921
Mailing Address - Country:US
Mailing Address - Phone:917-992-0639
Mailing Address - Fax:
Practice Address - Street 1:2925A KINGS HWY
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11229-1805
Practice Address - Country:US
Practice Address - Phone:718-382-0045
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-20
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR070429-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYNF03486091Medicare PIN