Provider Demographics
NPI:1972599884
Name:DWYER-GROVE, SHEILA M
Entity Type:Individual
Prefix:
First Name:SHEILA
Middle Name:M
Last Name:DWYER-GROVE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:211 NORMAN WAY
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16508-2964
Mailing Address - Country:US
Mailing Address - Phone:814-397-1629
Mailing Address - Fax:
Practice Address - Street 1:3910 CAUGHEY RD STE 120
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16506-4097
Practice Address - Country:US
Practice Address - Phone:814-397-1629
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-26
Last Update Date:2019-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPS004912-L103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAPS004912-LOtherPSYCHOLOGY LICENSE