1730195629 NPI number — MICHAEL P SHEA LCSW-C, MSW, ED.D.

Table of content: MICHAEL P SHEA LCSW-C, MSW, ED.D. (NPI 1730195629)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730195629 NPI number — MICHAEL P SHEA LCSW-C, MSW, ED.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHEA
Provider First Name:
MICHAEL
Provider Middle Name:
P
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LCSW-C, MSW, ED.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1730195629
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/09/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
347 LAUREL LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WAYNESBORO
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17268-1868
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
717-816-5882
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
324 E ANTIETAM ST STE 104
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HAGERSTOWN
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21740-5754
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
240-707-1454
Provider Business Practice Location Address Fax Number:
301-800-7808
Provider Enumeration Date:
07/31/2006

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:  SW8222 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 1041C0700X , with the licence number: 05426 , 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)

  • Identifier: 4573462 . This is a "AETNA" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 533585-03 . This is a "BCBS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 000395600 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 121731 . This is a "JOHN HOPKINS HEALTH CARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 5630890 . This is a "CIGNA" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: PHCS2233915 . This is a "PCHS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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