Healthcare Provider Details

I. General information

NPI: 1437088705
Provider Name (Legal Business Name): SHANSHAN WANG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/14/2026
Last Update Date: 05/14/2026
Certification Date: 05/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1354 HANCOCK ST STE 214
QUINCY MA
02169-5109
US

IV. Provider business mailing address

1354 HANCOCK ST STE 214
QUINCY MA
02169-5109
US

V. Phone/Fax

Practice location:
  • Phone: 617-471-5686
  • Fax: 617-471-6622
Mailing address:
  • Phone: 617-471-5686
  • Fax: 617-471-6622

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: