Healthcare Provider Details

I. General information

NPI: 1396208112
Provider Name (Legal Business Name): SHAWN ANDREW STRAUSBURG LISW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2019
Last Update Date: 08/14/2024
Certification Date: 08/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

683 WAIANAE AVE BLDG O
SCHOFIELD BARRACKS HI
96786
US

IV. Provider business mailing address

1061 HARMON AVE
FORT STEWART GA
31314-5641
US

V. Phone/Fax

Practice location:
  • Phone: 808-433-8601
  • Fax:
Mailing address:
  • Phone: 912-435-6965
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberI.2103266
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: