Provider Demographics
NPI:1992939037
Name:SCHNEIDER, SHELLEY LURAY (LCSW)
Entity type:Individual
Prefix:MRS
First Name:SHELLEY
Middle Name:LURAY
Last Name:SCHNEIDER
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 1:5130 S FLORIDA AVE
Mailing Address - Street 2:SUITE 408
Mailing Address - City:LAKELAND
Mailing Address - State:FL
Mailing Address - Zip Code:33813-2537
Mailing Address - Country:US
Mailing Address - Phone:863-648-0313
Mailing Address - Fax:
Practice Address - Street 1:5130 S FLORIDA AVE
Practice Address - Street 2:SUITE 408
Practice Address - City:LAKELAND
Practice Address - State:FL
Practice Address - Zip Code:33813-2537
Practice Address - Country:US
Practice Address - Phone:863-648-0313
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-04
Last Update Date:2009-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSW 55081041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical