Provider Demographics
NPI:1356499024
Name:SHIMER, JOHN MCGOWAN (DMIN)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:MCGOWAN
Last Name:SHIMER
Suffix:
Gender:M
Credentials:DMIN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:116 CENTRAL ST
Mailing Address - Street 2:
Mailing Address - City:ROWLEY
Mailing Address - State:MA
Mailing Address - Zip Code:01969-1317
Mailing Address - Country:US
Mailing Address - Phone:978-948-7666
Mailing Address - Fax:978-948-7666
Practice Address - Street 1:42 PLEASANT ST
Practice Address - Street 2:
Practice Address - City:NEWBURYPORT
Practice Address - State:MA
Practice Address - Zip Code:01950-2606
Practice Address - Country:US
Practice Address - Phone:978-465-3226
Practice Address - Fax:978-465-3226
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA3804103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA1890930OtherMBHP
MA6969-01OtherHPHC PACIFICARE
MA0516716Medicaid
MAW04090OtherBCBS OF MA
MA539827000OtherMAGELLAN
MA0516716Medicaid