Healthcare Provider Details

I. General information

NPI: 1871262436
Provider Name (Legal Business Name): SHUBH AGRAWAL M.ED., C.A.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2021
Last Update Date: 09/08/2021
Certification Date: 09/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 WEBSTER ST APT 410
BROOKLINE MA
02446-4964
US

IV. Provider business mailing address

61 LAMPLIGHTER DR
SHREWSBURY MA
01545-5456
US

V. Phone/Fax

Practice location:
  • Phone: 774-232-8183
  • Fax:
Mailing address:
  • Phone: 774-232-8183
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number504672
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: