Provider Demographics
NPI:1629558366
Name:HUBBARD, SHELBY FLANAGAN (LMSW-CC)
Entity type:Individual
Prefix:MRS
First Name:SHELBY
Middle Name:FLANAGAN
Last Name:HUBBARD
Suffix:
Gender:F
Credentials:LMSW-CC
Other - Prefix:MS
Other - First Name:SHELBY
Other - Middle Name:RYAN
Other - Last Name:FLANAGAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMSW-CC
Mailing Address - Street 1:55 FODEN ROAD
Mailing Address - Street 2:
Mailing Address - City:SOUTH PORTLAND
Mailing Address - State:ME
Mailing Address - Zip Code:04106
Mailing Address - Country:US
Mailing Address - Phone:207-854-1030
Mailing Address - Fax:207-899-4623
Practice Address - Street 1:55 FODEN ROAD
Practice Address - Street 2:
Practice Address - City:SOUTH PORTLAND
Practice Address - State:ME
Practice Address - Zip Code:04106
Practice Address - Country:US
Practice Address - Phone:207-854-1030
Practice Address - Fax:207-899-4623
Is Sole Proprietor?:Yes
Enumeration Date:2018-08-21
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEMC176011041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical