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Individual
SHANNON STAFFORD HERMAN MAPLE
Active
Individual
SHANNON STAFFORD HERMAN MAPLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LCSW-C
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
G13000
MD
1041C0700X
Clinical Social Worker
Primary
17635
MD
Other
Enumeration date
06/21/2010
Last updated
02/13/2015
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