1649503509 NPI number — SHAWNA MARIE LOPES-KEYES MA LMHC

Table of content: SHAWNA MARIE LOPES-KEYES MA LMHC (NPI 1649503509)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1649503509 NPI number — SHAWNA MARIE LOPES-KEYES MA LMHC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LOPES-KEYES
Provider First Name:
SHAWNA
Provider Middle Name:
MARIE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MA LMHC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
LOPES
Provider Other First Name:
SHAWNA
Provider Other Middle Name:
MARIE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
BA, MA, LMHC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1649503509
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/02/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5500 N MAIN ST
Provider Second Line Business Mailing Address:
17307
Provider Business Mailing Address City Name:
FALL RIVER
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
02720-2061
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-837-9145
Provider Business Mailing Address Fax Number:
774-955-5405

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
45 N MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 301
Provider Business Practice Location Address City Name:
FALL RIVER
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02720-2133
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-837-9145
Provider Business Practice Location Address Fax Number:
774-955-5405
Provider Enumeration Date:
09/10/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X , with the licence number:  8334 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 8334 . This is a "COMMONWEALTH OF MA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




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