Provider Demographics
NPI:1871262436
Name:AGRAWAL, SHUBH (MED, CAS)
Entity Type:Individual
Prefix:
First Name:SHUBH
Middle Name:
Last Name:AGRAWAL
Suffix:
Gender:F
Credentials:MED, CAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 LAMPLIGHTER DR
Mailing Address - Street 2:
Mailing Address - City:SHREWSBURY
Mailing Address - State:MA
Mailing Address - Zip Code:01545-5456
Mailing Address - Country:US
Mailing Address - Phone:774-232-8183
Mailing Address - Fax:
Practice Address - Street 1:20 WEBSTER ST APT 410
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-4964
Practice Address - Country:US
Practice Address - Phone:774-232-8183
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-09-08
Last Update Date:2021-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA504672101YS0200X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool