Provider Demographics
NPI:1760921977
Name:SHELAH COREY, LICSW, LLC
Entity Type:Organization
Organization Name:SHELAH COREY, LICSW, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHELAH
Authorized Official - Middle Name:
Authorized Official - Last Name:COREY
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:413-237-6862
Mailing Address - Street 1:33 MARENGO PARK
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01108-1733
Mailing Address - Country:US
Mailing Address - Phone:413-237-6862
Mailing Address - Fax:413-294-2679
Practice Address - Street 1:33 MARENGO PARK
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01108-1733
Practice Address - Country:US
Practice Address - Phone:413-237-6862
Practice Address - Fax:413-294-2679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-21
Last Update Date:2017-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1153471041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty