Provider Demographics
NPI:1720647662
Name:SHEA, DANIEL (MPA, MSW, LCSW, PMP)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:
Last Name:SHEA
Suffix:
Gender:M
Credentials:MPA, MSW, LCSW, PMP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1300 BIG BEND RD APT 549
Mailing Address - Street 2:
Mailing Address - City:BALLWIN
Mailing Address - State:MO
Mailing Address - Zip Code:63021-7837
Mailing Address - Country:US
Mailing Address - Phone:816-665-1267
Mailing Address - Fax:
Practice Address - Street 1:1 GRANT RD
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63125-4117
Practice Address - Country:US
Practice Address - Phone:314-527-8280
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-12
Last Update Date:2019-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical