Provider Demographics
NPI:1851414718
Name:SHEARIN, EDWARD NELSON (PHD)
Entity type:Individual
Prefix:
First Name:EDWARD
Middle Name:NELSON
Last Name:SHEARIN
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1550 WILSON BLVD
Mailing Address - Street 2:STE 600
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22209-2464
Mailing Address - Country:US
Mailing Address - Phone:703-526-5811
Mailing Address - Fax:703-243-8973
Practice Address - Street 1:1550 WILSON BLVD
Practice Address - Street 2:STE 600
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22209-2464
Practice Address - Country:US
Practice Address - Phone:703-526-5811
Practice Address - Fax:703-243-8973
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03221103TC0700X
NY011530103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical