Provider Demographics
NPI:1073286381
Name:CLAVELLE, SHAWN (MSW, LSW)
Entity Type:Individual
Prefix:MS
First Name:SHAWN
Middle Name:
Last Name:CLAVELLE
Suffix:
Gender:F
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:239 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17815-1726
Mailing Address - Country:US
Mailing Address - Phone:802-734-0380
Mailing Address - Fax:
Practice Address - Street 1:239 MARKET ST
Practice Address - Street 2:
Practice Address - City:BLOOMSBURG
Practice Address - State:PA
Practice Address - Zip Code:17815-1726
Practice Address - Country:US
Practice Address - Phone:802-734-0380
Practice Address - Fax:570-317-2891
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-01
Last Update Date:2021-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW138100104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker