Provider Demographics
NPI:1083226427
Name:NARDI-WILLIAMS, SHANE JS (LICSW)
Entity Type:Individual
Prefix:MR
First Name:SHANE
Middle Name:JS
Last Name:NARDI-WILLIAMS
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:MR
Other - First Name:SHANE
Other - Middle Name:JS
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8 BENNETTS XING
Mailing Address - Street 2:
Mailing Address - City:AYER
Mailing Address - State:MA
Mailing Address - Zip Code:01432-1770
Mailing Address - Country:US
Mailing Address - Phone:617-866-0207
Mailing Address - Fax:
Practice Address - Street 1:9 POND LN STE 3C
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:MA
Practice Address - Zip Code:01742-2863
Practice Address - Country:US
Practice Address - Phone:617-612-5089
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-18
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1227951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical