Provider Demographics
NPI:1154786341
Name:MCFADDEN, SHIRLEY (LMHC)
Entity type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:
Last Name:MCFADDEN
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18821 SPRING ST
Mailing Address - Street 2:
Mailing Address - City:ADAMS
Mailing Address - State:NY
Mailing Address - Zip Code:13605-3209
Mailing Address - Country:US
Mailing Address - Phone:315-767-5615
Mailing Address - Fax:
Practice Address - Street 1:18821 SPRING ST
Practice Address - Street 2:
Practice Address - City:ADAMS
Practice Address - State:NY
Practice Address - Zip Code:13605-3209
Practice Address - Country:US
Practice Address - Phone:315-767-5615
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-15
Last Update Date:2015-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY1942101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional