Provider Demographics
NPI:1538593884
Name:SHIREY, ANGIE
Entity type:Individual
Prefix:
First Name:ANGIE
Middle Name:
Last Name:SHIREY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:431A PENN ST
Mailing Address - Street 2:
Mailing Address - City:NEW BETHLEHEM
Mailing Address - State:PA
Mailing Address - Zip Code:16242-1113
Mailing Address - Country:US
Mailing Address - Phone:814-275-1237
Mailing Address - Fax:817-484-5004
Practice Address - Street 1:431A PENN ST
Practice Address - Street 2:
Practice Address - City:NEW BETHLEHEM
Practice Address - State:PA
Practice Address - Zip Code:16242-1113
Practice Address - Country:US
Practice Address - Phone:814-275-1237
Practice Address - Fax:817-484-5004
Is Sole Proprietor?:No
Enumeration Date:2013-08-22
Last Update Date:2019-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW128212104100000X
PACW0178061041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker