Healthcare Provider Details

I. General information

NPI: 1023928520
Provider Name (Legal Business Name): SHIANDRA CARDOSO BOWLES LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

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

III. Provider practice location address

175 PARAMOUNT DR UNIT 204
RAYNHAM MA
02767-1066
US

IV. Provider business mailing address

4 JACKSON ST
TAUNTON MA
02780-1712
US

V. Phone/Fax

Practice location:
  • Phone: 781-291-0217
  • Fax:
Mailing address:
  • Phone: 781-291-0217
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLMHC10004177
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: