Provider Demographics
NPI:1457729246
Name:DAMASO, SHANELLE (LCSW)
Entity Type:Individual
Prefix:
First Name:SHANELLE
Middle Name:
Last Name:DAMASO
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:SHANELLE
Other - Middle Name:
Other - Last Name:WALTERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4310 METRO PKWY STE 205
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33916-9416
Mailing Address - Country:US
Mailing Address - Phone:239-236-8784
Mailing Address - Fax:239-790-2624
Practice Address - Street 1:2721 DEL PRADO BLVD S STE 200
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33904-5783
Practice Address - Country:US
Practice Address - Phone:239-673-9034
Practice Address - Fax:239-673-9102
Is Sole Proprietor?:No
Enumeration Date:2015-09-10
Last Update Date:2021-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLW436-785-93-675-0171M00000X
FLSW173941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No171M00000XOther Service ProvidersCase Manager/Care Coordinator