MEDICARE: ELEANOR T SHUMAKER LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	0904000792	VA

General Provider Information

NPI Number	:	1407092984
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELEANOR T SHUMAKER LCSW

Provider Business Mailing Address
First Line	:	P.O. BOX 13296
Second Line	:
City	:	CHESAPEAKE
State	:	VA
Zip	:	23325
Country	:	US
Telephone Number	:	757-714-1838
Fax Number	:	757-321-6269

Provider Business Practice Location Address
First Line	:	464 INVESTORS PL STE 204L
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23452-1167
Country	:	US
Telephone Number	:	757-802-2510
Fax Number	:	757-321-6269

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/05/2009
Last Update Date	:	02/13/2011

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