Provider Demographics
NPI:1902590631
Name:KHAN, SHIREEN (LMSW)
Entity Type:Individual
Prefix:
First Name:SHIREEN
Middle Name:
Last Name:KHAN
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:AZAADI
Other - Middle Name:
Other - Last Name:KHAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMSW
Mailing Address - Street 1:27 CROOKE AVE APT 4B
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11226-9403
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:27 CROOKE AVE APT 4B
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11226-9403
Practice Address - Country:US
Practice Address - Phone:201-647-0951
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-06
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY111894104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker