MEDICARE: SHAA MARCUM LICSW

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	DP00944015	WV

General Provider Information

NPI Number	:	1235902909
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHAA MARCUM LICSW

Provider Business Mailing Address
First Line	:	21 BLUE SPRUCE LN
Second Line	:
City	:	DANVILLE
State	:	WV
Zip	:	25053-8003
Country	:	US
Telephone Number	:	312-965-8811
Fax Number	:

Provider Business Practice Location Address
First Line	:	501 CALDWELL LN
Second Line	:
City	:	DUNBAR
State	:	WV
Zip	:	25064-2026
Country	:	US
Telephone Number	:	312-965-8811
Fax Number	:

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

Provider Enumeration Date	:	11/03/2023
Last Update Date	:	03/19/2026

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