Provider Demographics
NPI:1962100842
Name:MUSGROVE, SHANIA (LSW)
Entity type:Individual
Prefix:
First Name:SHANIA
Middle Name:
Last Name:MUSGROVE
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 1:1021 GROVE ST
Mailing Address - Street 2:
Mailing Address - City:GREENSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:15601-3927
Mailing Address - Country:US
Mailing Address - Phone:724-961-2553
Mailing Address - Fax:
Practice Address - Street 1:1 NORTHGATE SQ STE 218
Practice Address - Street 2:
Practice Address - City:GREENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15601-1374
Practice Address - Country:US
Practice Address - Phone:724-689-6118
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-20
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASW141778104100000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker