Provider Demographics
NPI:1790814606
Name:SHAPANUS, SHARON SUE (LCSW, LMFT)
Entity Type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:SUE
Last Name:SHAPANUS
Suffix:
Gender:F
Credentials:LCSW, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2303 HURSTBOURNE VILLAGE DR
Mailing Address - Street 2:SUITE 1100
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40299-1830
Mailing Address - Country:US
Mailing Address - Phone:502-594-4864
Mailing Address - Fax:502-618-2875
Practice Address - Street 1:2303 HURSTBOURNE VILLAGE DR
Practice Address - Street 2:SUITE 1100
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40299-1830
Practice Address - Country:US
Practice Address - Phone:502-594-4864
Practice Address - Fax:502-618-2875
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY33521041C0700X
KY0759106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist