Provider Demographics
NPI:1407092984
Name:SHUMAKER, ELEANOR T (LCSW)
Entity Type:Individual
Prefix:
First Name:ELEANOR
Middle Name:T
Last Name:SHUMAKER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:ELLIE
Other - Middle Name:
Other - Last Name:SHUMAKER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 13296
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23325
Mailing Address - Country:US
Mailing Address - Phone:757-714-1838
Mailing Address - Fax:757-321-6269
Practice Address - Street 1:464 INVESTORS PL STE 204L
Practice Address - Street 2:
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-1167
Practice Address - Country:US
Practice Address - Phone:757-802-2510
Practice Address - Fax:757-321-6269
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-05
Last Update Date:2011-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040007921041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA00Y120C01Medicare PIN