Provider Demographics
NPI:1649753450
Name:MARTINS, SHANNAN (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:SHANNAN
Middle Name:
Last Name:MARTINS
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:333 TURNPIKE RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:01772-1755
Mailing Address - Country:US
Mailing Address - Phone:774-293-1418
Mailing Address - Fax:
Practice Address - Street 1:16 SUNRISE AVE
Practice Address - Street 2:
Practice Address - City:GRAFTON
Practice Address - State:MA
Practice Address - Zip Code:01519-1006
Practice Address - Country:US
Practice Address - Phone:774-293-1418
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-08
Last Update Date:2018-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1167481041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical