Provider Demographics
NPI:1821108705
Name:SHEARING, MARYLOU E (MSW)
Entity Type:Individual
Prefix:MS
First Name:MARYLOU
Middle Name:E
Last Name:SHEARING
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:455 W CENTER ST
Mailing Address - Street 2:SUITE 3 BOX 1
Mailing Address - City:WEST BRIDGEWATER
Mailing Address - State:MA
Mailing Address - Zip Code:02379-1637
Mailing Address - Country:US
Mailing Address - Phone:508-954-4431
Mailing Address - Fax:
Practice Address - Street 1:455 W CENTER ST
Practice Address - Street 2:SUITE 3 BOX 1
Practice Address - City:WEST BRIDGEWATER
Practice Address - State:MA
Practice Address - Zip Code:02379-1637
Practice Address - Country:US
Practice Address - Phone:508-954-4431
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2008-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA1052971041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA2078990OtherCIGNA/GUARDIAN PROV. NUMB
MA453450OtherTUFTS PROVIDER NUMBER
MA1005325OtherFALLON/NHP PROVIDER NUMBE
MA151805OtherVALUE OPTIONS/TRICARE/CHA
MA109603OtherHMO BLUE NUMBER
MA007377OtherHARVARD PILGRIM HEALTHCAR
MA2078990OtherCIGNA/GUARDIAN PROV. NUMB