Provider Demographics
NPI:1043757297
Name:SHANDOR, RENEE (LSW)
Entity Type:Individual
Prefix:
First Name:RENEE
Middle Name:
Last Name:SHANDOR
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:RENEE
Other - Middle Name:
Other - Last Name:CUNNINGHAM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LSW
Mailing Address - Street 1:451 LOUS RD
Mailing Address - Street 2:
Mailing Address - City:EBENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15931-4906
Mailing Address - Country:US
Mailing Address - Phone:814-533-9828
Mailing Address - Fax:
Practice Address - Street 1:451 LOUS RD
Practice Address - Street 2:
Practice Address - City:EBENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15931-4906
Practice Address - Country:US
Practice Address - Phone:814-533-9828
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-26
Last Update Date:2017-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW133342104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker