Provider Demographics
NPI:1427135979
Name:BACKMAN, SHAILEEN ROBIN (LCSW)
Entity type:Individual
Prefix:
First Name:SHAILEEN
Middle Name:ROBIN
Last Name:BACKMAN
Suffix:
Gender:F
Credentials:LCSW
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 217
Mailing Address - Street 2:
Mailing Address - City:PURCELLVILLE
Mailing Address - State:VA
Mailing Address - Zip Code:20134-0217
Mailing Address - Country:US
Mailing Address - Phone:540-338-3728
Mailing Address - Fax:
Practice Address - Street 1:24 N BUCKMARSH ST
Practice Address - Street 2:
Practice Address - City:BERRYVILLE
Practice Address - State:VA
Practice Address - Zip Code:22611-1062
Practice Address - Country:US
Practice Address - Phone:540-955-0780
Practice Address - Fax:540-955-0781
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA09040010361041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical