Provider Demographics
NPI:1942742440
Name:WASEL, SHANNON (LSW)
Entity Type:Individual
Prefix:MRS
First Name:SHANNON
Middle Name:
Last Name:WASEL
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:164 HILLCROFT WAY
Mailing Address - Street 2:
Mailing Address - City:NEWTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:18940-2315
Mailing Address - Country:US
Mailing Address - Phone:215-317-4066
Mailing Address - Fax:
Practice Address - Street 1:444 S STATE ST
Practice Address - Street 2:BUILDING A
Practice Address - City:NEWTOWN
Practice Address - State:PA
Practice Address - Zip Code:18940-1945
Practice Address - Country:US
Practice Address - Phone:215-317-4066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-15
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW132942104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker