MEDICARE: MRS. MARY LOU SHEWCHUK LICSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	106325	MA

General Provider Information

NPI Number	:	1942251103
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MARY LOU SHEWCHUK LICSW

Provider Business Mailing Address
First Line	:	8 ORCHARD WAY
Second Line	:
City	:	SANDWICH
State	:	MA
Zip	:	02563-2555
Country	:	US
Telephone Number	:	508-428-4234
Fax Number	:

Provider Business Practice Location Address
First Line	:	118 LONG POND RD
Second Line	:
City	:	PLYMOUTH
State	:	MA
Zip	:	02360-2662
Country	:	US
Telephone Number	:	508-747-6762
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/13/2006
Last Update Date	:	07/08/2007

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