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General NPI Number Information
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NPI Number | 1780425520
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Entity Type | Individual
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Provider Name | AMBER NICOLE SHANK LMSW
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Gender | Female
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Dates
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Enumeration Date | 06/05/2024
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Last Update Date | 06/05/2024
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Provider Practice Location Address
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Address Line | 13121 BROOK LANE
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City | HAGERSTOWN
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State | MD
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Zip | 21742
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Country | US
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Telephone | 301-733-0330
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Fax |
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Provider Business Mailing Address
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Address Line | 7 PARK ST
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City | MONT ALTO
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State | PA
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Zip | 17237-9657
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Country | US
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Telephone | 717-752-7684
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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 | 31615
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License Number State | MD
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