Provider Demographics
NPI:1215210695
Name:HAAS, SHANA LYNN (LCSW)
Entity Type:Individual
Prefix:
First Name:SHANA
Middle Name:LYNN
Last Name:HAAS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3257 STONEBRIDGE TRL
Mailing Address - Street 2:
Mailing Address - City:VALRICO
Mailing Address - State:FL
Mailing Address - Zip Code:33596-9252
Mailing Address - Country:US
Mailing Address - Phone:813-570-3017
Mailing Address - Fax:
Practice Address - Street 1:1200 W PLATT ST STE 204
Practice Address - Street 2:
Practice Address - City:TAMPA
Practice Address - State:FL
Practice Address - Zip Code:33606-2136
Practice Address - Country:US
Practice Address - Phone:813-434-3212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-22
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW151931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical