Provider Demographics
NPI:1346805025
Name:PHAM, SHAWN NGOC (MSW, LCSW)
Entity type:Individual
Prefix:MR
First Name:SHAWN
Middle Name:NGOC
Last Name:PHAM
Suffix:
Gender:M
Credentials:MSW, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13777 MUSKET CT
Mailing Address - Street 2:
Mailing Address - City:WOODBRIDGE
Mailing Address - State:VA
Mailing Address - Zip Code:22193-4425
Mailing Address - Country:US
Mailing Address - Phone:301-960-8430
Mailing Address - Fax:
Practice Address - Street 1:13777 MUSKET CT
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22193-4425
Practice Address - Country:US
Practice Address - Phone:301-960-8430
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-07
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040163051041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical