MEDICARE: DEBORAH K SHEARON 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
1	1041C0700X	Clinical Social Worker	0904003805	VA

General Provider Information

NPI Number	:	1821155102
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DEBORAH K SHEARON LCSW

Provider Business Mailing Address
First Line	:	3204 GLEN LAKE DR
Second Line	:
City	:	GLEN ALLEN
State	:	VA
Zip	:	23060-2626
Country	:	US
Telephone Number	:	804-647-6516
Fax Number	:

Provider Business Practice Location Address
First Line	:	4100 E PARHAM RD STE B
Second Line	:
City	:	RICHMOND
State	:	VA
Zip	:	23228-2760
Country	:	US
Telephone Number	:	804-647-6516
Fax Number	:

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

Provider Enumeration Date	:	01/03/2007
Last Update Date	:	07/08/2007

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