Provider Demographics
NPI:1255922050
Name:HANLEY, SHAHANA (LCSW)
Entity type:Individual
Prefix:
First Name:SHAHANA
Middle Name:
Last Name:HANLEY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3006 E BLOUNT ST
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-6504
Mailing Address - Country:US
Mailing Address - Phone:757-406-8838
Mailing Address - Fax:
Practice Address - Street 1:3006 E BLOUNT ST
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-6504
Practice Address - Country:US
Practice Address - Phone:757-406-8838
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-03
Last Update Date:2021-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL180381041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL18038OtherLICENSED CLINICAL SOCIAL WORKER