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General NPI Number Information
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NPI Number | 1659426534
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Entity Type | Individual
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Provider Name | SHAWN THOMAS SABELLA L.M.S.W.
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Gender | Male
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Dates
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Enumeration Date | 01/24/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 63 BROAD ST
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City | PLATTSBURGH
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State | NY
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Zip | 12901-3315
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Country | US
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Telephone | 518-563-8000
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Fax |
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Provider Business Mailing Address
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Address Line | 153 QUAKER HIGHLANDS RD
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City | PERU
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State | NY
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Zip | 12972-5180
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Country | US
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Telephone | 518-335-8009
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 104100000X
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Taxonomy Name | Social Worker
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License Number | 071106-1
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License Number State | NY
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