Provider Demographics
NPI:1548477847
Name:PRICE, KARYN RUTH (LMSW)
Entity type:Individual
Prefix:
First Name:KARYN
Middle Name:RUTH
Last Name:PRICE
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 1:14461 ROOSEVELT AVE
Mailing Address - Street 2:THE SHIELD INSTITUTE
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-6252
Mailing Address - Country:US
Mailing Address - Phone:718-229-5757
Mailing Address - Fax:718-939-0881
Practice Address - Street 1:39-09 214TH PLACE
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11361
Practice Address - Country:US
Practice Address - Phone:718-229-5757
Practice Address - Fax:718-939-0881
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-17
Last Update Date:2015-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY051121-1104100000X
NY079654104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY03512558Medicaid
NY03512558Medicaid