Provider Demographics
NPI:1114341088
Name:SHEA, PAMELA JM (LICSW)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:JM
Last Name:SHEA
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:545 FEDERAL ST
Mailing Address - Street 2:
Mailing Address - City:BELCHERTOWN
Mailing Address - State:MA
Mailing Address - Zip Code:01007-9756
Mailing Address - Country:US
Mailing Address - Phone:413-438-3372
Mailing Address - Fax:413-241-5158
Practice Address - Street 1:27 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:SOUTH HADLEY
Practice Address - State:MA
Practice Address - Zip Code:01075-1155
Practice Address - Country:US
Practice Address - Phone:413-438-3372
Practice Address - Fax:413-241-5158
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-12
Last Update Date:2023-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3609081041S0200X
MA1141981041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110106664AMedicaid
MA66882OtherHEALTH NEW ENGLAN
MA102637OtherMBHP
MAS400144071Medicaid