Provider Demographics
NPI:1679165161
Name:PARIS, SHARAE
Entity Type:Individual
Prefix:
First Name:SHARAE
Middle Name:
Last Name:PARIS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7715 CRITTENDEN ST # 220
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19118-4473
Mailing Address - Country:US
Mailing Address - Phone:215-839-6212
Mailing Address - Fax:
Practice Address - Street 1:1111 E JOHNSON ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19138-1017
Practice Address - Country:US
Practice Address - Phone:215-839-6212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-07
Last Update Date:2021-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW126820104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker