Provider Demographics
NPI:1225848849
Name:SHRIVER, ANNA MAE (LCSW)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:MAE
Last Name:SHRIVER
Suffix:
Gender:
Credentials:LCSW
Other - Prefix:
Other - First Name:MAE
Other - Middle Name:
Other - Last Name:SHRIVER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:801 SHERMAN AVE
Mailing Address - Street 2:
Mailing Address - City:EDWARDSVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62025-2370
Mailing Address - Country:US
Mailing Address - Phone:618-593-7943
Mailing Address - Fax:
Practice Address - Street 1:1701 N STATE ST
Practice Address - Street 2:
Practice Address - City:LITCHFIELD
Practice Address - State:IL
Practice Address - Zip Code:62056-1113
Practice Address - Country:US
Practice Address - Phone:217-324-4668
Practice Address - Fax:217-324-5693
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-08
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL26474531041S0200X
IL149.0248441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool