Provider Demographics
NPI:1407551294
Name:SHAPIRO-SHELLABY, MARIGNY SUZANNE (LCSW)
Entity Type:Individual
Prefix:
First Name:MARIGNY
Middle Name:SUZANNE
Last Name:SHAPIRO-SHELLABY
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 1:1200 CALLOWHILL ST STE 101
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19123-3658
Mailing Address - Country:US
Mailing Address - Phone:609-468-6253
Mailing Address - Fax:
Practice Address - Street 1:1200 CALLOWHILL ST STE 101
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19123-3658
Practice Address - Country:US
Practice Address - Phone:609-468-6253
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-03
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW1324571041C0700X
PACW0235721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical