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General NPI Number Information
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NPI Number | 1730195629
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Entity Type | Individual
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Provider Name | MICHAEL P SHEA LCSW-C, MSW, ED.D.
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Gender | Male
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Dates
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Enumeration Date | 07/31/2006
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Last Update Date | 02/09/2024
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Provider Practice Location Address
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Address Line | 324 E ANTIETAM ST STE 104
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City | HAGERSTOWN
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State | MD
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Zip | 21740-5754
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Country | US
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Telephone | 240-707-1454
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Fax | 301-800-7808
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Provider Business Mailing Address
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Address Line | 347 LAUREL LN
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City | WAYNESBORO
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State | PA
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Zip | 17268-1868
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Country | US
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Telephone | 717-816-5882
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | SW8222
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 05426
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License Number State | MD
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