Healthcare Provider Details

I. General information

NPI: 1629564133
Provider Name (Legal Business Name): SHELBY KIRSCH DWYER LMHC, RYT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/09/2018
Last Update Date: 07/09/2026
Certification Date: 07/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1770 MASSACHUSETTS AVE # 116
CAMBRIDGE MA
02140-2808
US

IV. Provider business mailing address

1770 MASSACHUSETTS AVE # 116
CAMBRIDGE MA
02140-2808
US

V. Phone/Fax

Practice location:
  • Phone: 617-616-8491
  • Fax: 617-812-9379
Mailing address:
  • Phone: 617-616-8491
  • Fax: 617-812-9379

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number8708
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: