Provider Demographics
NPI:1013625540
Name:PETRO, SHELBY LINN (LSW)
Entity Type:Individual
Prefix:
First Name:SHELBY
Middle Name:LINN
Last Name:PETRO
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 1:538 CHARLES AVE
Mailing Address - Street 2:
Mailing Address - City:KINGSTON
Mailing Address - State:PA
Mailing Address - Zip Code:18704-4712
Mailing Address - Country:US
Mailing Address - Phone:570-764-8755
Mailing Address - Fax:
Practice Address - Street 1:223 W BROAD ST
Practice Address - Street 2:
Practice Address - City:HAZLETON
Practice Address - State:PA
Practice Address - Zip Code:18201-6201
Practice Address - Country:US
Practice Address - Phone:570-455-9902
Practice Address - Fax:570-455-9452
Is Sole Proprietor?:No
Enumeration Date:2022-11-14
Last Update Date:2022-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW139593104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker