Provider Demographics
NPI:1205468287
Name:BARTH, SHANNON (LCSWC-C)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:
Last Name:BARTH
Suffix:
Gender:X
Credentials:LCSWC-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3570 OLNEY LAYTONSVILLE RD # 1704
Mailing Address - Street 2:
Mailing Address - City:OLNEY
Mailing Address - State:MD
Mailing Address - Zip Code:20832-9998
Mailing Address - Country:US
Mailing Address - Phone:443-808-0106
Mailing Address - Fax:
Practice Address - Street 1:3570 OLNEY LAYTONSVILLE RD # 1704
Practice Address - Street 2:
Practice Address - City:OLNEY
Practice Address - State:MD
Practice Address - Zip Code:20832-9998
Practice Address - Country:US
Practice Address - Phone:443-808-0106
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-07
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD208941041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical