MEDICARE: SHANNON BARTH LCSWC-C

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
1	1041C0700X	Clinical Social Worker	20894	MD

General Provider Information

NPI Number	:	1205468287
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHANNON BARTH LCSWC-C

Provider Business Mailing Address
First Line	:	3570 OLNEY LAYTONSVILLE RD # 1704
Second Line	:
City	:	OLNEY
State	:	MD
Zip	:	20832-9998
Country	:	US
Telephone Number	:	443-808-0106
Fax Number	:

Provider Business Practice Location Address
First Line	:	3570 OLNEY LAYTONSVILLE RD # 1704
Second Line	:
City	:	OLNEY
State	:	MD
Zip	:	20832-9998
Country	:	US
Telephone Number	:	443-808-0106
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/07/2020
Last Update Date	:	12/11/2024

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