Healthcare Provider Details

I. General information

NPI: 1952022253
Provider Name (Legal Business Name): MANDY SHAPIRO LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2022
Last Update Date: 09/11/2024
Certification Date: 09/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 GROVE ST
WORCESTER MA
01605-2651
US

IV. Provider business mailing address

108 GROVE ST
WORCESTER MA
01605-2651
US

V. Phone/Fax

Practice location:
  • Phone: 508-304-7499
  • Fax:
Mailing address:
  • Phone: 508-304-7499
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number313740
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number230048
License Number StateMA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: