Provider Demographics
NPI:1316141252
Name:MORASCO, SHAWNA M (LCSW-R)
Entity type:Individual
Prefix:
First Name:SHAWNA
Middle Name:M
Last Name:MORASCO
Suffix:
Gender:F
Credentials:LCSW-R
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:138 NORTH COURT STREET
Mailing Address - Street 2:
Mailing Address - City:WAMPSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13163
Mailing Address - Country:US
Mailing Address - Phone:315-366-2327
Mailing Address - Fax:
Practice Address - Street 1:138 NORTH COURT ST
Practice Address - Street 2:
Practice Address - City:WAMPSVILLE
Practice Address - State:NY
Practice Address - Zip Code:13163
Practice Address - Country:US
Practice Address - Phone:315-366-2327
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0787791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1041C0700XOtherMSW
NY1073629358Medicaid