Healthcare Provider Details

I. General information

NPI: 1265597009
Provider Name (Legal Business Name): SHAWN MICHELLE VANVESSEN L.C.S.W.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/22/2006
Last Update Date: 02/08/2022
Certification Date: 01/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 TUSKEGEE BLVD
DOVER DE
19902-5003
US

IV. Provider business mailing address

667 EQUITATION LN
FELTON DE
19943-2735
US

V. Phone/Fax

Practice location:
  • Phone: 302-677-2711
  • Fax:
Mailing address:
  • Phone: 302-284-4535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberQ1-0000486
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: