Provider Demographics
NPI:1134961394
Name:SHINDEL, BLAINE SCOTT (LSW)
Entity type:Individual
Prefix:
First Name:BLAINE
Middle Name:SCOTT
Last Name:SHINDEL
Suffix:
Gender:M
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1218 PHILADELPHIA ST
Mailing Address - Street 2:
Mailing Address - City:INDIANA
Mailing Address - State:PA
Mailing Address - Zip Code:15701-1617
Mailing Address - Country:US
Mailing Address - Phone:717-574-9903
Mailing Address - Fax:
Practice Address - Street 1:1097 OAK ST LOWR LEVEL
Practice Address - Street 2:
Practice Address - City:INDIANA
Practice Address - State:PA
Practice Address - Zip Code:15701-1651
Practice Address - Country:US
Practice Address - Phone:724-349-2022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-10
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW139480104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker