1609099654 NPI number — MRS. SHANA JANINE MISLAK MSW LCSW C CCDC

Table of content: VICTORIA ELIZABETH RIBBLE LMSW (NPI 1740822733)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609099654 NPI number — MRS. SHANA JANINE MISLAK MSW LCSW C CCDC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MISLAK
Provider First Name:
SHANA
Provider Middle Name:
JANINE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MSW LCSW C CCDC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BURNS
Provider Other First Name:
SHANA
Provider Other Middle Name:
J
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1609099654
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/11/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
801 CHANCE CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
STREET
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21154
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-893-7217
Provider Business Mailing Address Fax Number:
410-893-7217

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
801 CHANCE CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
STREET
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21154
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-893-7217
Provider Business Practice Location Address Fax Number:
410-893-7217
Provider Enumeration Date:
04/10/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X , with the licence number:  1142CCDC , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: 06960 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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