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General NPI Number Information
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NPI Number | 1497897250
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Entity Type | Organization
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Legal Business Name | FRIENDS OF THE SHATTUCK SHELTER
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Dates
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Enumeration Date | 02/12/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 170 MORTON ST
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City | JAMAICA PLAIN
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State | MA
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Zip | 02130-3735
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Country | US
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Telephone | 617-983-0351
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Fax | 617-971-9339
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Provider Business Mailing Address
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Address Line | 170 MORTON ST
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City | JAMAICA PLAIN
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State | MA
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Zip | 02130-3735
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Country | US
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Telephone | 617-983-0351
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Fax | 617-971-9339
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Authorized Official
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Title or Position | DIRECTOR OF PROGRAM DEVELOPMENT
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Name | MRS. DEBORAH PUTNAM
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Credential | MPH, MSW
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Telephone | 617-983-0351
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 0796
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License Number State | MA
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