Provider Demographics
NPI:1730195629
Name:SHEA, MICHAEL P (LCSW-C, MSW, EDD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:P
Last Name:SHEA
Suffix:
Gender:M
Credentials:LCSW-C, MSW, EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:347 LAUREL LN
Mailing Address - Street 2:
Mailing Address - City:WAYNESBORO
Mailing Address - State:PA
Mailing Address - Zip Code:17268-1868
Mailing Address - Country:US
Mailing Address - Phone:717-816-5882
Mailing Address - Fax:
Practice Address - Street 1:324 E ANTIETAM ST STE 104
Practice Address - Street 2:
Practice Address - City:HAGERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21740-5754
Practice Address - Country:US
Practice Address - Phone:240-707-1454
Practice Address - Fax:301-800-7808
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW82221041C0700X
MD054261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD4573462OtherAETNA
MD533585-03OtherBCBS
MD000395600Medicaid
MD121731OtherJOHN HOPKINS HEALTH CARE
MD5630890OtherCIGNA
MDPHCS2233915OtherPCHS