Provider Demographics
NPI:1417226291
Name:SHRYOCK, NORMA CONSUELO (LCSW)
Entity Type:Individual
Prefix:
First Name:NORMA
Middle Name:CONSUELO
Last Name:SHRYOCK
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:PSC 490
Mailing Address - Street 2:BOX 9044
Mailing Address - City:FPO
Mailing Address - State:AP
Mailing Address - Zip Code:96538-0490
Mailing Address - Country:US
Mailing Address - Phone:671-344-7550
Mailing Address - Fax:671-344-9597
Practice Address - Street 1:BLDG 1 FARENHOLT AVENUE
Practice Address - Street 2:
Practice Address - City:AGANA HEIGHTS
Practice Address - State:GU
Practice Address - Zip Code:96910
Practice Address - Country:US
Practice Address - Phone:671-344-7550
Practice Address - Fax:671-344-9597
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-22
Last Update Date:2023-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI37201041C0700X
HILCSW3720104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker