Provider Demographics
NPI:1386017796
Name:BEAUZIL, SHELLA (MSW, LICSW)
Entity Type:Individual
Prefix:
First Name:SHELLA
Middle Name:
Last Name:BEAUZIL
Suffix:
Gender:F
Credentials:MSW, LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 201302
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44120-8105
Mailing Address - Country:US
Mailing Address - Phone:617-816-9862
Mailing Address - Fax:
Practice Address - Street 1:63 BAKERSFIELD ST
Practice Address - Street 2:
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02125-1920
Practice Address - Country:US
Practice Address - Phone:617-816-9862
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-06
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1236401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical