Provider Demographics
NPI:1649319013
Name:PATRICE, SHANTANETTE (MSW)
Entity type:Individual
Prefix:
First Name:SHANTANETTE
Middle Name:
Last Name:PATRICE
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1010 MASSACHUSETTS AVENUE
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02118
Mailing Address - Country:US
Mailing Address - Phone:617-534-2398
Mailing Address - Fax:617-534-4688
Practice Address - Street 1:55 NEW DUDLEY ST
Practice Address - Street 2:JOHN D OBRYANT SBHC
Practice Address - City:ROXBURY
Practice Address - State:MA
Practice Address - Zip Code:02119
Practice Address - Country:US
Practice Address - Phone:617-534-9940
Practice Address - Fax:617-534-9948
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041S0200XBehavioral Health & Social Service ProvidersSocial WorkerSchool