Provider Demographics
NPI:1295906071
Name:SHAVATT, BARBARA LYNN (LCSW-C)
Entity type:Individual
Prefix:
First Name:BARBARA
Middle Name:LYNN
Last Name:SHAVATT
Suffix:
Gender:F
Credentials:LCSW-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8131 RITCHIE HWY
Mailing Address - Street 2:SUITE G
Mailing Address - City:PASADENA
Mailing Address - State:MD
Mailing Address - Zip Code:21122-6940
Mailing Address - Country:US
Mailing Address - Phone:410-491-3331
Mailing Address - Fax:410-437-2407
Practice Address - Street 1:8131 RITCHIE HWY
Practice Address - Street 2:SUITE G
Practice Address - City:PASADENA
Practice Address - State:MD
Practice Address - Zip Code:21122-6940
Practice Address - Country:US
Practice Address - Phone:410-491-3331
Practice Address - Fax:410-437-2407
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-19
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD084721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD08472OtherLICENSED SOCAL WORKER