Broadwater, Shirley Marie
Broadwater, Shirley Marie is an sole proprietor health care provider with primary practice located at 1111 Houser Rd , Fayetteville PA 17222-9731. She recently has only one registered license in Behavioral Health & Social Service Providers / Counseling, which is considered as her primary health care specialty. Broadwater, Shirley Marie can be contacted via phone (717) 352-2857.Contact Information
Primary practice address
1111 Houser Rd
Fayetteville PA 17222-9731
Phone: (717) 352-2857
Fax: (717) 352-2857
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Counseling | 103TC1900X | PS005001-L | Pennsylvania |
Profile Details
| NPI number | 1659583599 |
|---|---|
| LBN Legal business name | Broadwater, Shirley Marie |
| Credentials | M.S. |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | May 4th, 2007 |
| Last updated | Jul 8th, 2007 - about 17 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1659583599 | NPPES |
| Pennsylvania | Other | BR519094 | PIN |
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