Provider Demographics
NPI:1629014527
Name:HANLON, SHELLY (MSW, PSYD)
Entity Type:Individual
Prefix:
First Name:SHELLY
Middle Name:
Last Name:HANLON
Suffix:
Gender:F
Credentials:MSW, PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6315 FORBES AVE
Mailing Address - Street 2:GROUND LEVEL OFFICES
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15217-1745
Mailing Address - Country:US
Mailing Address - Phone:412-422-1464
Mailing Address - Fax:412-421-2255
Practice Address - Street 1:6315 FORBES AVE
Practice Address - Street 2:GROUND LEVEL OFFICES
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15217-1745
Practice Address - Country:US
Practice Address - Phone:412-422-1464
Practice Address - Fax:412-421-2255
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW002413L1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA263754OtherBLUE SHIELD
PA263754OtherBLUE SHIELD
PAR08228Medicare UPIN