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NPI Code Detail

MEDICARE: ROSEMARY S SHADE LCSW

MEDICARE: ROSEMARY S SHADE LCSW
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
11041C0700XClinical Social WorkerCW013492PA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1093713406
Entity Type Code : Individual
Provider Name (Legal Business Name) : ROSEMARY S SHADE LCSW
Provider Business Mailing Address
First Line : 200 NORTH 7TH STREET
Second Line :
City : LEBANON
State : PA
Zip : 17046
Country : US
Telephone Number : 717-273-1710
Fax Number : 717-273-1416
Provider Business Practice Location Address
First Line : 1733 PENN AVE
Second Line :
City : READING
State : PA
Zip : 19609-2054
Country : US
Telephone Number : 610-670-7270
Fax Number : 610-678-3825
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/09/2005
Last Update Date : 07/02/2019

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Directions to “ ROSEMARY S SHADE LCSW” Practice Location

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