Provider Demographics
NPI:1780425520
Name:SHANK, AMBER NICOLE (LMSW)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:NICOLE
Last Name:SHANK
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 PARK ST
Mailing Address - Street 2:
Mailing Address - City:MONT ALTO
Mailing Address - State:PA
Mailing Address - Zip Code:17237-9657
Mailing Address - Country:US
Mailing Address - Phone:717-752-7684
Mailing Address - Fax:
Practice Address - Street 1:13121 BROOK LANE
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21742
Practice Address - Country:US
Practice Address - Phone:301-733-0330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-06-05
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD31615104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker