Provider Demographics
NPI:1497501837
Name:SPEAR, SHELLEY (MSW,LCSW)
Entity type:Individual
Prefix:
First Name:SHELLEY
Middle Name:
Last Name:SPEAR
Suffix:
Gender:F
Credentials:MSW,LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:627 GLEN ECHO RD
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19119-2919
Mailing Address - Country:US
Mailing Address - Phone:215-917-6945
Mailing Address - Fax:
Practice Address - Street 1:627 GLEN ECHO RD
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19119-2919
Practice Address - Country:US
Practice Address - Phone:215-917-6945
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-26
Last Update Date:2024-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PACW002692L1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical