Provider Demographics
NPI:1295145621
Name:WARD, SHANA (PHD)
Entity type:Individual
Prefix:DR
First Name:SHANA
Middle Name:
Last Name:WARD
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 FRONT AVE
Mailing Address - Street 2:SUITE 204
Mailing Address - City:LUTHERVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21093-5300
Mailing Address - Country:US
Mailing Address - Phone:443-912-1230
Mailing Address - Fax:888-972-8138
Practice Address - Street 1:1400 FRONT AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:LUTHERVILLE
Practice Address - State:MD
Practice Address - Zip Code:21093-5300
Practice Address - Country:US
Practice Address - Phone:443-912-1230
Practice Address - Fax:888-972-8138
Is Sole Proprietor?:No
Enumeration Date:2014-05-07
Last Update Date:2014-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD04112103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool