Provider Demographics
NPI:1164456935
Name:SHEA-ZAJAC, DEBRA (LMHC/RN)
Entity Type:Individual
Prefix:
First Name:DEBRA
Middle Name:
Last Name:SHEA-ZAJAC
Suffix:
Gender:F
Credentials:LMHC/RN
Other - Prefix:
Other - First Name:DEBRA
Other - Middle Name:
Other - Last Name:SHEA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:4 SAMPSON RD
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:01050-9757
Mailing Address - Country:US
Mailing Address - Phone:413-667-0271
Mailing Address - Fax:413-667-0276
Practice Address - Street 1:1132 WESTFIELD ST
Practice Address - Street 2:
Practice Address - City:WEST SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01089-3878
Practice Address - Country:US
Practice Address - Phone:413-592-1980
Practice Address - Fax:413-439-0096
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4273101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health