Provider Demographics
NPI:1861118010
Name:LEE, SHAKEENA B (MSW, LSW)
Entity type:Individual
Prefix:
First Name:SHAKEENA
Middle Name:B
Last Name:LEE
Suffix:
Gender:F
Credentials:MSW, LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:953 MARKET ST
Mailing Address - Street 2:
Mailing Address - City:WILLIAMSPORT
Mailing Address - State:PA
Mailing Address - Zip Code:17701-3448
Mailing Address - Country:US
Mailing Address - Phone:570-601-4325
Mailing Address - Fax:570-866-3141
Practice Address - Street 1:953 MARKET ST
Practice Address - Street 2:
Practice Address - City:WILLIAMSPORT
Practice Address - State:PA
Practice Address - Zip Code:17701-3448
Practice Address - Country:US
Practice Address - Phone:570-601-4325
Practice Address - Fax:570-866-3141
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-18
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASWL137132101YA0400X
PASW137132104100000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial Worker