Healthcare Provider Details

I. General information

NPI: 1467789818
Provider Name (Legal Business Name): KIRSTEN SHUO-HUEI SHIH M.A
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/05/2009
Last Update Date: 05/18/2022
Certification Date: 05/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

70 FORSYTH ST
BOSTON MA
02115-5026
US

IV. Provider business mailing address

348 CANTON ST
RANDOLPH MA
02368-1507
US

V. Phone/Fax

Practice location:
  • Phone: 617-774-2772
  • Fax:
Mailing address:
  • Phone: 857-277-3913
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225A00000X
TaxonomyMusic Therapist
License Number10122
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number9429
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: