Provider Demographics
NPI:1750450938
Name:MUSTAFA, SHAHEER (LICSW)
Entity Type:Individual
Prefix:
First Name:SHAHEER
Middle Name:
Last Name:MUSTAFA
Suffix:
Gender:M
Credentials:LICSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:46 ORCHARD AVE
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:RI
Mailing Address - Zip Code:02806-4626
Mailing Address - Country:US
Mailing Address - Phone:617-549-9863
Mailing Address - Fax:401-245-8148
Practice Address - Street 1:406 MASSACHUSETTS AVE
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:MA
Practice Address - Zip Code:02474-6700
Practice Address - Country:US
Practice Address - Phone:781-643-2580
Practice Address - Fax:781-643-2598
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1131911041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical