Provider Demographics
NPI:1194574913
Name:SHAKESPEARE, CAMILLA CASSANDRA (LMSW)
Entity type:Individual
Prefix:MS
First Name:CAMILLA
Middle Name:CASSANDRA
Last Name:SHAKESPEARE
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:MRS
Other - First Name:CAMILLA
Other - Middle Name:CASSANDRA
Other - Last Name:HOFFMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3607 STONESBORO RD
Mailing Address - Street 2:
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20744-1334
Mailing Address - Country:US
Mailing Address - Phone:267-266-1596
Mailing Address - Fax:
Practice Address - Street 1:9015 WOODYARD RD STE 202-203
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-4209
Practice Address - Country:US
Practice Address - Phone:301-899-6222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-14
Last Update Date:2024-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD30818104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker