Provider Demographics
NPI:1881326825
Name:SHAW-GONZALES, DENNISHA MICHELLE (LSW)
Entity type:Individual
Prefix:
First Name:DENNISHA
Middle Name:MICHELLE
Last Name:SHAW-GONZALES
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1331 12TH AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:ALTOONA
Mailing Address - State:PA
Mailing Address - Zip Code:16601-3340
Mailing Address - Country:US
Mailing Address - Phone:814-201-2754
Mailing Address - Fax:
Practice Address - Street 1:1331 12TH AVE
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16601-3340
Practice Address - Country:US
Practice Address - Phone:814-201-2754
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-06-28
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW139338104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker