Provider Demographics
NPI:1982223590
Name:SHEA, MARY ROGERS
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:ROGERS
Last Name:SHEA
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 1:12 HOWARD ST
Mailing Address - Street 2:
Mailing Address - City:BRAINTREE
Mailing Address - State:MA
Mailing Address - Zip Code:02184-1608
Mailing Address - Country:US
Mailing Address - Phone:781-964-2553
Mailing Address - Fax:
Practice Address - Street 1:400 WASHINGTON ST STE 106
Practice Address - Street 2:
Practice Address - City:BRAINTREE
Practice Address - State:MA
Practice Address - Zip Code:02184-4764
Practice Address - Country:US
Practice Address - Phone:781-817-6675
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-14
Last Update Date:2020-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty