Provider Demographics
NPI:1669539003
Name:STAHL, SHELLEY ANN (MSW, LICSW)
Entity type:Individual
Prefix:MS
First Name:SHELLEY
Middle Name:ANN
Last Name:STAHL
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 WIDGER RD
Mailing Address - Street 2:SUITE 305
Mailing Address - City:MARBLEHEAD
Mailing Address - State:MA
Mailing Address - Zip Code:01945-2146
Mailing Address - Country:US
Mailing Address - Phone:781-639-4071
Mailing Address - Fax:978-777-8667
Practice Address - Street 1:7 FEDERAL ST
Practice Address - Street 2:35
Practice Address - City:DANVERS
Practice Address - State:MA
Practice Address - Zip Code:01923-3620
Practice Address - Country:US
Practice Address - Phone:781-639-4071
Practice Address - Fax:978-777-8667
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1037721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical