Provider Demographics
NPI:1184141921
Name:SHAFI, MARIAM AISHA (LMSW)
Entity type:Individual
Prefix:
First Name:MARIAM
Middle Name:AISHA
Last Name:SHAFI
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 WOODLAND DR
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-6086
Mailing Address - Country:US
Mailing Address - Phone:817-233-1432
Mailing Address - Fax:
Practice Address - Street 1:1527 HEMPHILL ST
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76104-4706
Practice Address - Country:US
Practice Address - Phone:817-569-5900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-23
Last Update Date:2017-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical