Provider Demographics
NPI:1366036790
Name:SHIELDS, MARY MARGARET (LICSW)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:MARGARET
Last Name:SHIELDS
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 1:22 JAMES ST APT 5
Mailing Address - Street 2:
Mailing Address - City:BROOKLINE
Mailing Address - State:MA
Mailing Address - Zip Code:02446-3714
Mailing Address - Country:US
Mailing Address - Phone:617-549-2535
Mailing Address - Fax:
Practice Address - Street 1:22 JAMES ST APT 5
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-3714
Practice Address - Country:US
Practice Address - Phone:617-549-2535
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-25
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1043931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical