Provider Demographics
NPI:1306559968
Name:SHOBER, HAILEE VIVIAN (LSW)
Entity type:Individual
Prefix:MISS
First Name:HAILEE
Middle Name:VIVIAN
Last Name:SHOBER
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 STONEHOUSE BND
Mailing Address - Street 2:
Mailing Address - City:WILLOW STREET
Mailing Address - State:PA
Mailing Address - Zip Code:17584-7800
Mailing Address - Country:US
Mailing Address - Phone:717-917-3822
Mailing Address - Fax:
Practice Address - Street 1:41 E ORANGE ST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:PA
Practice Address - Zip Code:17602-2846
Practice Address - Country:US
Practice Address - Phone:717-393-3900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-12-28
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
PASW1420911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health