Provider Demographics
NPI:1003177387
Name:SHEA, BRIAN P (MA)
Entity Type:Individual
Prefix:MR
First Name:BRIAN
Middle Name:P
Last Name:SHEA
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:50 PARK ROW W
Mailing Address - Street 2:#426
Mailing Address - City:PROVIDENCE
Mailing Address - State:RI
Mailing Address - Zip Code:02903-1177
Mailing Address - Country:US
Mailing Address - Phone:617-455-2788
Mailing Address - Fax:
Practice Address - Street 1:50 PARK ROW W
Practice Address - Street 2:#426
Practice Address - City:PROVIDENCE
Practice Address - State:RI
Practice Address - Zip Code:02903-1177
Practice Address - Country:US
Practice Address - Phone:617-455-2788
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-04
Last Update Date:2012-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor