Provider Demographics
NPI:1558842294
Name:SHIELDS, MADELINE MARY
Entity Type:Individual
Prefix:MS
First Name:MADELINE
Middle Name:MARY
Last Name:SHIELDS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 STANDISH ST
Mailing Address - Street 2:
Mailing Address - City:DUXBURY
Mailing Address - State:MA
Mailing Address - Zip Code:02332-5027
Mailing Address - Country:US
Mailing Address - Phone:781-635-8457
Mailing Address - Fax:
Practice Address - Street 1:859 WILLARD ST STE 430
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-7490
Practice Address - Country:US
Practice Address - Phone:617-847-1909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-21
Last Update Date:2018-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical