Provider Demographics
NPI:1972893733
Name:AVA BARRON-SHASHO, LCSW-C, LLC
Entity type:Organization
Organization Name:AVA BARRON-SHASHO, LCSW-C, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AVA
Authorized Official - Middle Name:IRIS
Authorized Official - Last Name:BARRON-SHASHO
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:410-356-0796
Mailing Address - Street 1:10806 REISTERSTOWN RD
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-2700
Mailing Address - Country:US
Mailing Address - Phone:410-356-0796
Mailing Address - Fax:
Practice Address - Street 1:10806 REISTERSTOWN RD
Practice Address - Street 2:SUITE 1B
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-2700
Practice Address - Country:US
Practice Address - Phone:410-356-0796
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-13
Last Update Date:2011-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD086551041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD207595Medicare PIN