Provider Demographics
NPI:1043650237
Name:BORUM, SHANINE A (LCSWC)
Entity Type:Individual
Prefix:MS
First Name:SHANINE
Middle Name:A
Last Name:BORUM
Suffix:
Gender:F
Credentials:LCSWC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 BELLFALLS WAY
Mailing Address - Street 2:
Mailing Address - City:NOTTINGHAM
Mailing Address - State:MD
Mailing Address - Zip Code:21236-4790
Mailing Address - Country:US
Mailing Address - Phone:410-782-1888
Mailing Address - Fax:
Practice Address - Street 1:24 BELLFALLS WAY
Practice Address - Street 2:
Practice Address - City:NOTTINGHAM
Practice Address - State:MD
Practice Address - Zip Code:21236-4790
Practice Address - Country:US
Practice Address - Phone:410-782-1888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-02
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD198601041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical