Provider Demographics
NPI:1871253856
Name:SHEA, CHANTAL AIMEE (LICSW)
Entity Type:Individual
Prefix:MRS
First Name:CHANTAL
Middle Name:AIMEE
Last Name:SHEA
Suffix:
Gender:F
Credentials:LICSW
Other - Prefix:
Other - First Name:CHANTAL
Other - Middle Name:AIMEE
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:165 BOURNE AVE
Mailing Address - Street 2:
Mailing Address - City:RUMFORD
Mailing Address - State:RI
Mailing Address - Zip Code:02916-3322
Mailing Address - Country:US
Mailing Address - Phone:401-523-0344
Mailing Address - Fax:
Practice Address - Street 1:1240 PAWTUCKET AVE
Practice Address - Street 2:
Practice Address - City:RUMFORD
Practice Address - State:RI
Practice Address - Zip Code:02916-1427
Practice Address - Country:US
Practice Address - Phone:401-491-4938
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-12-18
Last Update Date:2021-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RIISW034261041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical