Provider Demographics
NPI:1992972673
Name:SHAVERS, IKIA (MSW)
Entity type:Individual
Prefix:
First Name:IKIA
Middle Name:
Last Name:SHAVERS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8723 W CHESTER PIKE APT C4
Mailing Address - Street 2:
Mailing Address - City:UPPER DARBY
Mailing Address - State:PA
Mailing Address - Zip Code:19082-1112
Mailing Address - Country:US
Mailing Address - Phone:215-783-0693
Mailing Address - Fax:610-957-5406
Practice Address - Street 1:8723 W CHESTER PIKE APT C4
Practice Address - Street 2:
Practice Address - City:UPPER DARBY
Practice Address - State:PA
Practice Address - Zip Code:19082-1112
Practice Address - Country:US
Practice Address - Phone:215-783-0693
Practice Address - Fax:610-957-5406
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-13
Last Update Date:2008-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker