Healthcare Provider Details

I. General information

NPI: 1023930112
Provider Name (Legal Business Name): RIZWANA KITTY SHAFIQUE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2026
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 HANCOCK ST # 901
QUINCY MA
02171-1745
US

IV. Provider business mailing address

15 DESMOINES RD UNIT 102
QUINCY MA
02169-8763
US

V. Phone/Fax

Practice location:
  • Phone: 617-410-9328
  • 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:
Title or Position:
Credential:
Phone: