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General NPI Number Information
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NPI Number | 1992257687
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Entity Type | Individual
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Provider Name | AMY LYNN SHIVES LCSW-C
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Gender | Female
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Dates
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Enumeration Date | 10/27/2016
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Last Update Date | 04/25/2023
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Provider Practice Location Address
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Address Line | 111 E MAIN ST STE B
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City | ELKTON
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State | MD
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Zip | 21921-5996
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Country | US
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Telephone | 434-406-3234
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Fax |
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Provider Business Mailing Address
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Address Line | 185 ADMIRAL COCHRANE DR STE 120
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City | ANNAPOLIS
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State | MD
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Zip | 21401-7600
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Country | US
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Telephone | 443-440-5788
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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 | 17883
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License Number State | MD
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