Provider Demographics
NPI:1962166769
Name:MORGAN, SHAWN RAYMOND (LCSW)
Entity type:Individual
Prefix:
First Name:SHAWN
Middle Name:RAYMOND
Last Name:MORGAN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 BUFFINGTON STREET
Mailing Address - Street 2:BUILDING 25, ROOM 315
Mailing Address - City:WATERVLIET ARSENAL
Mailing Address - State:NY
Mailing Address - Zip Code:12189
Mailing Address - Country:US
Mailing Address - Phone:518-641-2161
Mailing Address - Fax:
Practice Address - Street 1:1 BUFFINGTON STREET
Practice Address - Street 2:BUILDING 25, ROOM 315
Practice Address - City:WATERVLIET ARSENAL
Practice Address - State:NY
Practice Address - Zip Code:12189
Practice Address - Country:US
Practice Address - Phone:518-641-2161
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-27
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY73-0718741041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical