Provider Demographics
NPI:1407478019
Name:HERBERT, SHIRLEY A (LCSW-C)
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:A
Last Name:HERBERT
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2710 SUMMERVIEW WAY APT 302
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-7760
Mailing Address - Country:US
Mailing Address - Phone:410-533-8940
Mailing Address - Fax:
Practice Address - Street 1:701 BESTGATE RD
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-2117
Practice Address - Country:US
Practice Address - Phone:443-906-3506
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-18
Last Update Date:2020-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD112701041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical