Provider Demographics
NPI:1356486351
Name:WARREN, SHELLY (LICSW)
Entity Type:Individual
Prefix:
First Name:SHELLY
Middle Name:
Last Name:WARREN
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 1:91 HOPKINS PL
Mailing Address - Street 2:
Mailing Address - City:LONGMEADOW
Mailing Address - State:MA
Mailing Address - Zip Code:01106-1942
Mailing Address - Country:US
Mailing Address - Phone:413-827-8959
Mailing Address - Fax:413-827-7015
Practice Address - Street 1:38 BALDWIN ST
Practice Address - Street 2:
Practice Address - City:EAST LONGMEADOW
Practice Address - State:MA
Practice Address - Zip Code:01028-2201
Practice Address - Country:US
Practice Address - Phone:413-237-6921
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2116871041C0700X
1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical