Provider Demographics
NPI:1851582308
Name:LEVESQUE, SHAWN MARIE
Entity Type:Individual
Prefix:
First Name:SHAWN
Middle Name:MARIE
Last Name:LEVESQUE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1157 SOUTH RD
Mailing Address - Street 2:
Mailing Address - City:WAKEFIELD
Mailing Address - State:RI
Mailing Address - Zip Code:02879-7633
Mailing Address - Country:US
Mailing Address - Phone:401-789-1367
Mailing Address - Fax:401-783-2558
Practice Address - Street 1:1157 SOUTH RD
Practice Address - Street 2:
Practice Address - City:WAKEFIELD
Practice Address - State:RI
Practice Address - Zip Code:02879-7633
Practice Address - Country:US
Practice Address - Phone:401-789-1367
Practice Address - Fax:401-783-2558
Is Sole Proprietor?:No
Enumeration Date:2007-08-08
Last Update Date:2007-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI151101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health