Provider Demographics
NPI:1629226642
Name:SHOPPER, EVAN
Entity Type:Individual
Prefix:
First Name:EVAN
Middle Name:
Last Name:SHOPPER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:238 MAIN ST
Mailing Address - Street 2:FOURTH FLOOR
Mailing Address - City:GREENFIELD
Mailing Address - State:MA
Mailing Address - Zip Code:01301-3243
Mailing Address - Country:US
Mailing Address - Phone:413-774-6252
Mailing Address - Fax:413-773-0477
Practice Address - Street 1:238 MAIN ST
Practice Address - Street 2:FOURTH FLOOR
Practice Address - City:GREENFIELD
Practice Address - State:MA
Practice Address - Zip Code:01301-3243
Practice Address - Country:US
Practice Address - Phone:413-774-6252
Practice Address - Fax:413-773-0477
Is Sole Proprietor?:No
Enumeration Date:2008-09-03
Last Update Date:2008-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker