Provider Demographics
NPI:1245735265
Name:SHAPIRO, EDYTHE A (LCSW)
Entity Type:Individual
Prefix:
First Name:EDYTHE
Middle Name:A
Last Name:SHAPIRO
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 1:1290 BALTIMORE PIKE STE 200
Mailing Address - Street 2:
Mailing Address - City:CHADDS FORD
Mailing Address - State:PA
Mailing Address - Zip Code:19317-7361
Mailing Address - Country:US
Mailing Address - Phone:610-558-9600
Mailing Address - Fax:610-601-1540
Practice Address - Street 1:1290 BALTIMORE PIKE STE 200
Practice Address - Street 2:
Practice Address - City:CHADDS FORD
Practice Address - State:PA
Practice Address - Zip Code:19317-7361
Practice Address - Country:US
Practice Address - Phone:610-558-9600
Practice Address - Fax:610-601-1540
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-30
Last Update Date:2018-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA0176141041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty