Basic Information
| Provider Information | |||||||||
| NPI: | 1003410812 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | DIAS | ||||||||
| FirstName: | SHAWN | ||||||||
| MiddleName: | PAUL | ||||||||
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| Credential: | BS, MA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 124 MENDALL RD | ||||||||
| Address2: | |||||||||
| City: | ACUSHNET | ||||||||
| State: | MA | ||||||||
| PostalCode: | 027431238 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5089653845 | ||||||||
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| Practice Location | |||||||||
| Address1: | 543 NORTH ST | ||||||||
| Address2: | |||||||||
| City: | NEW BEDFORD | ||||||||
| State: | MA | ||||||||
| PostalCode: | 027402782 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5089845566 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/23/2020 | ||||||||
| LastUpdateDate: | 11/23/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 11/23/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | MA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.