Provider Demographics
NPI:1003475419
Name:CHURCH, SHAYNA PAULINE (LMSW)
Entity Type:Individual
Prefix:
First Name:SHAYNA
Middle Name:PAULINE
Last Name:CHURCH
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:SHAYNA
Other - Middle Name:PAULINE
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:300 TALBOT ST
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:MD
Mailing Address - Zip Code:21601-3525
Mailing Address - Country:US
Mailing Address - Phone:410-822-1018
Mailing Address - Fax:410-820-5884
Practice Address - Street 1:300 TALBOT ST
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:MD
Practice Address - Zip Code:21601-3525
Practice Address - Country:US
Practice Address - Phone:410-822-1018
Practice Address - Fax:410-820-5884
Is Sole Proprietor?:No
Enumeration Date:2019-06-10
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker