Provider Demographics
NPI:1588858617
Name:STEENROD, SHELLEY ANN (PHD, LICSW)
Entity Type:Individual
Prefix:DR
First Name:SHELLEY
Middle Name:ANN
Last Name:STEENROD
Suffix:
Gender:F
Credentials:PHD, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4244
Mailing Address - Street 2:BALARDVALE STATION
Mailing Address - City:ANDOVER
Mailing Address - State:MA
Mailing Address - Zip Code:01810-0814
Mailing Address - Country:US
Mailing Address - Phone:978-474-0252
Mailing Address - Fax:
Practice Address - Street 1:OLD ANDOVER VILLAGE MALL
Practice Address - Street 2:91 MAIN STREET
Practice Address - City:ANDOVER
Practice Address - State:MA
Practice Address - Zip Code:01810-3848
Practice Address - Country:US
Practice Address - Phone:978-764-8764
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-31
Last Update Date:2011-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10211541041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical