Provider Demographics
NPI:1619336377
Name:SHOEMAKER, LARA (MSW, LISW-S)
Entity Type:Individual
Prefix:
First Name:LARA
Middle Name:
Last Name:SHOEMAKER
Suffix:
Gender:F
Credentials:MSW, LISW-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:414 N DETROIT ST
Mailing Address - Street 2:
Mailing Address - City:WEST LIBERTY
Mailing Address - State:OH
Mailing Address - Zip Code:43357-9690
Mailing Address - Country:US
Mailing Address - Phone:937-465-0010
Mailing Address - Fax:
Practice Address - Street 1:414 N DETROIT ST
Practice Address - Street 2:
Practice Address - City:WEST LIBERTY
Practice Address - State:OH
Practice Address - Zip Code:43357-9690
Practice Address - Country:US
Practice Address - Phone:937-465-0010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-23
Last Update Date:2016-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHI13035731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical