Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor |
NPI | 1003261926 |
---|---|
Provider Name | Justine Shamey |
First Address | Lansford, PA 18232-1819 |
Second Address | Lansford, PA 18232-1819 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/04/2016 |
Last Update Date | 28/04/2016 |