Provider Demographics
NPI:1790395671
Name:SHANLEY, PATRICK (LCSW)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:
Last Name:SHANLEY
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:72 HIGHLAND ST UNIT 2
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:MA
Mailing Address - Zip Code:02465-2405
Mailing Address - Country:US
Mailing Address - Phone:615-430-4351
Mailing Address - Fax:
Practice Address - Street 1:115 MILL ST
Practice Address - Street 2:MCLEAN HOSPITAL MAIL STOP 106
Practice Address - City:BELMONT
Practice Address - State:MA
Practice Address - Zip Code:02478
Practice Address - Country:US
Practice Address - Phone:617-855-3615
Practice Address - Fax:617-855-2515
Is Sole Proprietor?:Yes
Enumeration Date:2020-08-05
Last Update Date:2020-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical