Provider Demographics
NPI:1043433238
Name:SHIPE, DAVID LEWIS (R-LCSW)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:LEWIS
Last Name:SHIPE
Suffix:
Gender:M
Credentials:R-LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:628 BARNES AVE
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:NY
Mailing Address - Zip Code:13207-2509
Mailing Address - Country:US
Mailing Address - Phone:315-469-8298
Mailing Address - Fax:315-469-8298
Practice Address - Street 1:628 BARNES AVE
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13207-2509
Practice Address - Country:US
Practice Address - Phone:315-469-8298
Practice Address - Fax:315-469-8298
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYR019953-11041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical