Provider Demographics
NPI:1376969709
Name:SHAMON, DEVORA SARA (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:DEVORA
Middle Name:SARA
Last Name:SHAMON
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:DEBBI
Other - Middle Name:SARA
Other - Last Name:SHAMON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:88 OAK ST
Mailing Address - Street 2:
Mailing Address - City:WESTWOOD
Mailing Address - State:MA
Mailing Address - Zip Code:02090-3217
Mailing Address - Country:US
Mailing Address - Phone:617-325-4078
Mailing Address - Fax:
Practice Address - Street 1:88 OAK ST
Practice Address - Street 2:
Practice Address - City:WESTWOOD
Practice Address - State:MA
Practice Address - Zip Code:02090-3217
Practice Address - Country:US
Practice Address - Phone:617-325-4078
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-10
Last Update Date:2014-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1159791041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical