Provider Demographics
NPI:1477738235
Name:DRAKE, SHELLEY ANNA (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:SHELLEY
Middle Name:ANNA
Last Name:DRAKE
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:249 ISLINGTON ST
Mailing Address - Street 2:SUITE 11
Mailing Address - City:PORTSMOUTH
Mailing Address - State:NH
Mailing Address - Zip Code:03801-4266
Mailing Address - Country:US
Mailing Address - Phone:603-828-5716
Mailing Address - Fax:
Practice Address - Street 1:249 ISLINGTON ST
Practice Address - Street 2:SUITE 11
Practice Address - City:PORTSMOUTH
Practice Address - State:NH
Practice Address - Zip Code:03801-4266
Practice Address - Country:US
Practice Address - Phone:603-828-5716
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-29
Last Update Date:2015-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH15571041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NHP01119090OtherRAILROAD MEDICARE
NH33400075Medicaid
NH2973401Medicare PIN