Provider Demographics
NPI:1225053127
Name:SHICKMANTER, BARBARA K
Entity Type:Individual
Prefix:MS
First Name:BARBARA
Middle Name:K
Last Name:SHICKMANTER
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 1:50 DUNMARE CT
Mailing Address - Street 2:
Mailing Address - City:LENOX
Mailing Address - State:MA
Mailing Address - Zip Code:01240-2613
Mailing Address - Country:US
Mailing Address - Phone:413-637-2577
Mailing Address - Fax:
Practice Address - Street 1:15 LENOX ST
Practice Address - Street 2:JEWISH FAMILY SERVICE OF W MASS
Practice Address - City:SPRINGFIELD
Practice Address - State:MA
Practice Address - Zip Code:01108
Practice Address - Country:US
Practice Address - Phone:413-737-2601
Practice Address - Fax:413-737-0323
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA105916104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
PO3784OtherBLUE CROSS BLUE SHIELD MA
SHP23575Medicare ID - Type Unspecified