1851864821 NPI number — SHAWNNEICE BETH BROCK MSW, LICSW, PIP

Table of content: SHAWNNEICE BETH BROCK MSW, LICSW, PIP (NPI 1851864821)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851864821 NPI number — SHAWNNEICE BETH BROCK MSW, LICSW, PIP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BROCK
Provider First Name:
SHAWNNEICE
Provider Middle Name:
BETH
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSW, LICSW, PIP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BROCK
Provider Other First Name:
SHAWN
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MSW. LICSW, PIP
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1851864821
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/02/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
SPARKS CENTER 1720 7TH AVENUE SOUTH- 9TH FLOOR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BIRMINGHAM
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35294-0017
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-934-5201
Provider Business Mailing Address Fax Number:
205-975-4879

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
SPARKS CENTER 1720 7TH AVENUE SOUTH- 9TH FLOOR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BIRMINGHAM
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35294-0017
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-934-5201
Provider Business Practice Location Address Fax Number:
205-975-4879
Provider Enumeration Date:
01/02/2019

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: 1041C0700X , with the licence number:  0581C , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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