Provider Demographics
NPI:1912210584
Name:SHEA, MICHELLE TERESE (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:TERESE
Last Name:SHEA
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:TERESE
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1730 MINOR AVE
Mailing Address - Street 2:STE 1600
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-1466
Mailing Address - Country:US
Mailing Address - Phone:509-241-7938
Mailing Address - Fax:
Practice Address - Street 1:555 PACIFIC AVE STE 202
Practice Address - Street 2:
Practice Address - City:BREMERTON
Practice Address - State:WA
Practice Address - Zip Code:98337-1903
Practice Address - Country:US
Practice Address - Phone:360-782-1700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-07-23
Last Update Date:2021-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALW607011291041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical