Provider Demographics
NPI:1831166974
Name:HALES, SHAWN WILLIS (PSYD)
Entity type:Individual
Prefix:DR
First Name:SHAWN
Middle Name:WILLIS
Last Name:HALES
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2204 MARYLAND AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MA
Mailing Address - Zip Code:21218
Mailing Address - Country:US
Mailing Address - Phone:410-467-6040
Mailing Address - Fax:410-735-5898
Practice Address - Street 1:1111 WASHINGTON BLVD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21230
Practice Address - Country:US
Practice Address - Phone:410-467-6040
Practice Address - Fax:410-783-0569
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD3352103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist