Provider Demographics
NPI:1376520429
Name:SHAFEEK, BERIEL (MA LSW LICDC)
Entity Type:Individual
Prefix:MRS
First Name:BERIEL
Middle Name:
Last Name:SHAFEEK
Suffix:
Gender:F
Credentials:MA LSW LICDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1320 WOODMAN DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45432-3497
Mailing Address - Country:US
Mailing Address - Phone:937-223-1781
Mailing Address - Fax:937-853-0096
Practice Address - Street 1:1320 WOODMAN DR
Practice Address - Street 2:SUITE 200
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45432-3497
Practice Address - Country:US
Practice Address - Phone:937-223-1781
Practice Address - Fax:937-853-0096
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH943836101YA0400X
OHS 00203061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Not Answered1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2272231Medicaid