Healthcare Provider Details

I. General information

NPI: 1992083687
Provider Name (Legal Business Name): SHAUNTE MICHELE KEE LICSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/28/2011
Last Update Date: 03/27/2025
Certification Date: 03/27/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 WAMPANOAG TRL UNIT 400
RIVERSIDE RI
02915-1507
US

IV. Provider business mailing address

231 MAIN ST SUITE 300
BROCKTON MA
02301-4342
US

V. Phone/Fax

Practice location:
  • Phone: 401-785-0040
  • Fax: 508-427-1505
Mailing address:
  • Phone: 508-586-2660
  • Fax: 508-427-1505

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberISW04316
License Number StateRI
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberLICSW120754
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: