Provider Demographics
NPI:1447685169
Name:FUTTERMAN, SHIRA E (PSYD)
Entity type:Individual
Prefix:DR
First Name:SHIRA
Middle Name:E
Last Name:FUTTERMAN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:152 E 35TH ST
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-4179
Mailing Address - Country:US
Mailing Address - Phone:516-662-9707
Mailing Address - Fax:
Practice Address - Street 1:152 E 35TH ST
Practice Address - Street 2:SUITE B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-4179
Practice Address - Country:US
Practice Address - Phone:516-662-9707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-12
Last Update Date:2013-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY020030103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist