Healthcare Provider Details

I. General information

NPI: 1083531032
Provider Name (Legal Business Name): AS ABOVE WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

33 WINONA ST
BROCKTON MA
02301-5485
US

IV. Provider business mailing address

33 WINONA ST APT 3
BROCKTON MA
02301-5488
US

V. Phone/Fax

Practice location:
  • Phone: 617-752-2462
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: KRISTINE SHAW
Title or Position: OWNER
Credential: LMHC
Phone: 617-953-9367