Provider Demographics
NPI:1245763788
Name:HODGE, SHAUNA (MS)
Entity Type:Individual
Prefix:
First Name:SHAUNA
Middle Name:
Last Name:HODGE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42 SUNSET RD
Mailing Address - Street 2:
Mailing Address - City:WINTHROP
Mailing Address - State:MA
Mailing Address - Zip Code:02152-2771
Mailing Address - Country:US
Mailing Address - Phone:508-863-3270
Mailing Address - Fax:
Practice Address - Street 1:42 SUNSET RD
Practice Address - Street 2:
Practice Address - City:WINTHROP
Practice Address - State:MA
Practice Address - Zip Code:02152-2771
Practice Address - Country:US
Practice Address - Phone:508-863-3270
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-11
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst