Provider Demographics
NPI:1831832492
Name:WAITES-HOWARD, SHIRLEY JEAN (PHD, MSS, LSW)
Entity type:Individual
Prefix:DR
First Name:SHIRLEY
Middle Name:JEAN
Last Name:WAITES-HOWARD
Suffix:
Gender:F
Credentials:PHD, MSS, LSW
Other - Prefix:DR
Other - First Name:SHIRLEY
Other - Middle Name:JEAN
Other - Last Name:WAITES-HOWARD
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD, MSS, LSW
Mailing Address - Street 1:1508 HARDING BLVD
Mailing Address - Street 2:
Mailing Address - City:NORRISTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19401-2932
Mailing Address - Country:US
Mailing Address - Phone:121-529-2229
Mailing Address - Fax:
Practice Address - Street 1:7306-08 OGONTZ AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19138-1306
Practice Address - Country:US
Practice Address - Phone:215-292-2290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-04-20
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW-005967-E104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PASW-005967-EMedicaid