Provider Demographics
NPI:1639137433
Name:RITZERT, SHANNON L (LSW)
Entity Type:Individual
Prefix:
First Name:SHANNON
Middle Name:L
Last Name:RITZERT
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:699 E STATE ST
Mailing Address - Street 2:
Mailing Address - City:SHARON
Mailing Address - State:PA
Mailing Address - Zip Code:16146-2057
Mailing Address - Country:US
Mailing Address - Phone:724-983-3820
Mailing Address - Fax:724-983-3941
Practice Address - Street 1:348 MAIN ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:PA
Practice Address - Zip Code:16125-2608
Practice Address - Country:US
Practice Address - Phone:724-588-7814
Practice Address - Fax:724-588-7986
Is Sole Proprietor?:No
Enumeration Date:2006-05-02
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW0160361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
455279000OtherMAGELLAN
2117692OtherCIGNA BEHAVIORAL HEALTH