Healthcare Provider Details

I. General information

NPI: 1225053127
Provider Name (Legal Business Name): MS. BARBARA K SHICKMANTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 LENOX ST JEWISH FAMILY SERVICE OF W MASS
SPRINGFIELD MA
01108
US

IV. Provider business mailing address

50 DUNMARE CT
LENOX MA
01240-2613
US

V. Phone/Fax

Practice location:
  • Phone: 413-737-2601
  • Fax: 413-737-0323
Mailing address:
  • Phone: 413-637-2577
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number105916
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: