Provider Demographics
NPI:1740329705
Name:SHEHADI, ELIZABETH ANNE (LICSW)
Entity type:Individual
Prefix:MS
First Name:ELIZABETH
Middle Name:ANNE
Last Name:SHEHADI
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:189 UPPER BAY RD
Mailing Address - Street 2:
Mailing Address - City:SANBORNTON
Mailing Address - State:NH
Mailing Address - Zip Code:03269-2722
Mailing Address - Country:US
Mailing Address - Phone:603-528-6057
Mailing Address - Fax:
Practice Address - Street 1:111 CHURCH ST
Practice Address - Street 2:
Practice Address - City:LACONIA
Practice Address - State:NH
Practice Address - Zip Code:03246-3432
Practice Address - Country:US
Practice Address - Phone:603-524-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH4961041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH889984AOtherMVP HEALTHCARE
NH1049359Y0NH01OtherANTHEM