Provider Demographics
NPI:1851366538
Name:FLYNN-SHAW, MARYELIZABETH (MSW)
Entity Type:Individual
Prefix:
First Name:MARYELIZABETH
Middle Name:
Last Name:FLYNN-SHAW
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:MARYELIZABETH
Other - Middle Name:FLYNN
Other - Last Name:SHAW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MSW
Mailing Address - Street 1:3 WOODLAND RD STE 418
Mailing Address - Street 2:
Mailing Address - City:STONEHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02180-1714
Mailing Address - Country:US
Mailing Address - Phone:781-662-6213
Mailing Address - Fax:
Practice Address - Street 1:3 WOODLAND RD
Practice Address - Street 2:STE 418
Practice Address - City:STONEHAM
Practice Address - State:MA
Practice Address - Zip Code:02180
Practice Address - Country:US
Practice Address - Phone:781-662-6213
Practice Address - Fax:781-665-9860
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-17
Last Update Date:2010-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA10201931041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA5000014OtherTUFTS HEALTH PLAN
MAUGWBXE-01OtherUBH
9392078OtherAETNA BEHAVIORAL HEALTH
9392078OtherAETNA BEHAVIORAL HEALTH
MAP06185Medicare ID - Type Unspecified