Provider Demographics
NPI:1578070504
Name:MADELEINE SHAVER, LCSW LLC
Entity Type:Organization
Organization Name:MADELEINE SHAVER, LCSW LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MADELEINE
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAVER
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW, MAC
Authorized Official - Phone:912-272-5744
Mailing Address - Street 1:700 COMMERCIAL CT STE 102
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31406-3675
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:912-335-6559
Practice Address - Street 1:700 COMMERCIAL CT STE 102
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31406-3675
Practice Address - Country:US
Practice Address - Phone:912-272-5744
Practice Address - Fax:912-335-6559
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-28
Last Update Date:2017-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC009266101YP2500X
GACSW0047051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA1477880383OtherCORESOURSE
GA1477880383OtherUMR
GA1477880383OtherTRICARE STANDARD
GA1477880383OtherBCBS