Provider Demographics
NPI:1295765709
Name:SHAGOURY, BARBARA RANAH (LLICSW)
Entity type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:RANAH
Last Name:SHAGOURY
Suffix:
Gender:F
Credentials:LLICSW
Other - Prefix:MS
Other - First Name:RANAH
Other - Middle Name:
Other - Last Name:SHAGOURY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LICSW
Mailing Address - Street 1:1361 ELM ST
Mailing Address - Street 2:SUITE 407
Mailing Address - City:MANCHESTER
Mailing Address - State:NH
Mailing Address - Zip Code:03101
Mailing Address - Country:US
Mailing Address - Phone:603-668-3050
Mailing Address - Fax:603-668-8666
Practice Address - Street 1:1361 ELM ST
Practice Address - Street 2:SUITE 407
Practice Address - City:MANCHESTER
Practice Address - State:NH
Practice Address - Zip Code:03101
Practice Address - Country:US
Practice Address - Phone:603-668-3050
Practice Address - Fax:603-668-8666
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH406104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
GRRE6930Medicare ID - Type Unspecified