Provider Demographics
NPI:1164909990
Name:SHAVERS, EFE IGHO-OSAGIE
Entity Type:Individual
Prefix:
First Name:EFE
Middle Name:IGHO-OSAGIE
Last Name:SHAVERS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 PHILIP RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:MA
Mailing Address - Zip Code:02421-6022
Mailing Address - Country:US
Mailing Address - Phone:209-298-7137
Mailing Address - Fax:
Practice Address - Street 1:9 PHILIP RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MA
Practice Address - Zip Code:02421-6022
Practice Address - Country:US
Practice Address - Phone:209-298-7137
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-24
Last Update Date:2018-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool