Provider Demographics
NPI:1205146503
Name:TRACHTMAN, SHEILA R (LCSW)
Entity type:Individual
Prefix:MS
First Name:SHEILA
Middle Name:R
Last Name:TRACHTMAN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 OCEAN PKWY APT 5E
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11230-7817
Mailing Address - Country:US
Mailing Address - Phone:718-859-2994
Mailing Address - Fax:
Practice Address - Street 1:715 OCEAN PKWY APT 5E
Practice Address - Street 2:
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11230-7817
Practice Address - Country:US
Practice Address - Phone:718-859-2994
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-20
Last Update Date:2010-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYRO33845-11041C0700X
NYRO033845-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYN7506OtherEMPIRE BL UECROSS AND BLUE SHIELD