Provider Demographics
NPI:1306693346
Name:SHIRK, CLARISSA MARRIE (LSW)
Entity type:Individual
Prefix:
First Name:CLARISSA
Middle Name:MARRIE
Last Name:SHIRK
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:PO BOX 454
Mailing Address - Street 2:
Mailing Address - City:LAMAR
Mailing Address - State:PA
Mailing Address - Zip Code:16848-0454
Mailing Address - Country:US
Mailing Address - Phone:570-377-0151
Mailing Address - Fax:
Practice Address - Street 1:4702 NITTANY VALLEY DRIVE
Practice Address - Street 2:
Practice Address - City:LAMAR
Practice Address - State:PA
Practice Address - Zip Code:16848
Practice Address - Country:US
Practice Address - Phone:570-377-0151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-06
Last Update Date:2024-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW140081104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker