Provider Demographics
NPI:1447929039
Name:STANLEY, SHAUN E (LICSW)
Entity type:Individual
Prefix:MR
First Name:SHAUN
Middle Name:E
Last Name:STANLEY
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30 FAIRVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:RI
Mailing Address - Zip Code:02842-4950
Mailing Address - Country:US
Mailing Address - Phone:401-924-1054
Mailing Address - Fax:
Practice Address - Street 1:300 HIGHPOINT AVE
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:RI
Practice Address - Zip Code:02871-1445
Practice Address - Country:US
Practice Address - Phone:401-213-9597
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-08
Last Update Date:2025-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW039671041C0700X, 1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical