Provider Demographics
NPI:1861823841
Name:FITCHETT, SHANE (LGSW)
Entity Type:Individual
Prefix:
First Name:SHANE
Middle Name:
Last Name:FITCHETT
Suffix:
Gender:F
Credentials:LGSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9475 LOTTSFORD RD
Mailing Address - Street 2:250
Mailing Address - City:LARGO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-5357
Mailing Address - Country:US
Mailing Address - Phone:301-636-6504
Mailing Address - Fax:301-636-6509
Practice Address - Street 1:9475 LOTTSFORD RD
Practice Address - Street 2:250
Practice Address - City:LARGO
Practice Address - State:MD
Practice Address - Zip Code:20774-5357
Practice Address - Country:US
Practice Address - Phone:301-636-6504
Practice Address - Fax:301-636-6509
Is Sole Proprietor?:No
Enumeration Date:2013-12-02
Last Update Date:2013-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD192381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical