Provider Demographics
NPI:1760619837
Name:MCCRAE, SHELLY RENE (LCSW-C)
Entity Type:Individual
Prefix:MS
First Name:SHELLY
Middle Name:RENE
Last Name:MCCRAE
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4500 CHAUCER WAY
Mailing Address - Street 2:UNIT 106
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-6606
Mailing Address - Country:US
Mailing Address - Phone:410-653-1607
Mailing Address - Fax:
Practice Address - Street 1:4500 CHAUCER WAY
Practice Address - Street 2:UNIT 106
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-6606
Practice Address - Country:US
Practice Address - Phone:410-653-1607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-16
Last Update Date:2009-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLC500787131041C0700X
MD121891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical