Basic Information
| Provider Information | |||||||||
| NPI: | 1144274473 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | SHAPIRO | ||||||||
| FirstName: | JENNIFER | ||||||||
| MiddleName: | |||||||||
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| Credential: | LICSW | ||||||||
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| OtherLastName: | COTE | ||||||||
| OtherFirstName: | JENNIFER | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 74 HINCKLEY ST | ||||||||
| Address2: | #2 | ||||||||
| City: | SOMERVILLE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 021452538 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6174165169 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 77 E MERRIMACK ST | ||||||||
| Address2: | SUITE 1 | ||||||||
| City: | LOWELL | ||||||||
| State: | MA | ||||||||
| PostalCode: | 018521251 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9784536800 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/20/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 113450 | MA | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.