Provider Demographics
NPI:1588195929
Name:EMILY SHIELDS UPPAL, LLC
Entity Type:Organization
Organization Name:EMILY SHIELDS UPPAL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:SHIELDS
Authorized Official - Last Name:UPPAL
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:919-271-8568
Mailing Address - Street 1:113 SUMNER ST
Mailing Address - Street 2:APT 21
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02128-2318
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:113 SUMNER ST
Practice Address - Street 2:APT 21
Practice Address - City:BOSTON
Practice Address - State:MA
Practice Address - Zip Code:02128-2318
Practice Address - Country:US
Practice Address - Phone:919-271-8568
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-27
Last Update Date:2017-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty